Provider Demographics
NPI:1174911465
Name:HEALTHSOURCE GLOBAL
Entity type:Organization
Organization Name:HEALTHSOURCE GLOBAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-458-8973
Mailing Address - Street 1:39270 PASEO PADRE PKWY
Mailing Address - Street 2:138
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1616
Mailing Address - Country:US
Mailing Address - Phone:800-458-8973
Mailing Address - Fax:
Practice Address - Street 1:39270 PASEO PADRE PKWY
Practice Address - Street 2:138
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1616
Practice Address - Country:US
Practice Address - Phone:800-458-8973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA955322282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital