Provider Demographics
NPI:1952124711
Name:DP CRYOTHERAPY
Entity type:Organization
Organization Name:DP CRYOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-872-7097
Mailing Address - Street 1:451 SERENITY POINT DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5843
Mailing Address - Country:US
Mailing Address - Phone:949-872-7097
Mailing Address - Fax:
Practice Address - Street 1:451 SERENITY POINT DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-5843
Practice Address - Country:US
Practice Address - Phone:949-872-7097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No253Z00000XAgenciesIn Home Supportive Care