Provider Demographics
NPI:1275897217
Name:AIRWAY THERAPEUTIC MANAGEMENT, INC
Entity Type:Organization
Organization Name:AIRWAY THERAPEUTIC MANAGEMENT, INC
Other - Org Name:AIRWAY THERAPEUTIC MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:LIETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-279-4950
Mailing Address - Street 1:509 N SMITH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-6902
Mailing Address - Country:US
Mailing Address - Phone:951-279-4950
Mailing Address - Fax:951-279-4994
Practice Address - Street 1:509 N SMITH AVE STE 105
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-6902
Practice Address - Country:US
Practice Address - Phone:951-279-4950
Practice Address - Fax:951-279-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3449283251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health