Provider Demographics
NPI:1881249563
Name:DAPHCO
Entity type:Organization
Organization Name:DAPHCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-616-4156
Mailing Address - Street 1:2920 W OLIVE AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4546
Mailing Address - Country:US
Mailing Address - Phone:888-616-4156
Mailing Address - Fax:818-960-0134
Practice Address - Street 1:2920 W OLIVE AVE STE 113
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4546
Practice Address - Country:US
Practice Address - Phone:888-616-4156
Practice Address - Fax:888-616-8965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881249563Medicaid