Provider Demographics
NPI:1366755845
Name:TIMOTHY P OBRIEN DBA ETA SUPPLIES
Entity type:Organization
Organization Name:TIMOTHY P OBRIEN DBA ETA SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANCONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-792-4700
Mailing Address - Street 1:1518 LINDA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1953
Mailing Address - Country:US
Mailing Address - Phone:626-792-4700
Mailing Address - Fax:
Practice Address - Street 1:1518 LINDA VISTA AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1953
Practice Address - Country:US
Practice Address - Phone:626-792-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies