Provider Demographics
NPI:1881968022
Name:FIRST DIABETES
Entity type:Organization
Organization Name:FIRST DIABETES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-598-5700
Mailing Address - Street 1:20535 E WALNUT DR N
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2945
Mailing Address - Country:US
Mailing Address - Phone:909-598-5700
Mailing Address - Fax:909-598-5709
Practice Address - Street 1:20535 E WALNUT DR N
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2945
Practice Address - Country:US
Practice Address - Phone:909-598-5700
Practice Address - Fax:909-598-5709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELECTROMED ENGINEERING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment