Provider Demographics
NPI:1730454448
Name:LIFE FORCE DME
Entity type:Organization
Organization Name:LIFE FORCE DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:619-250-1703
Mailing Address - Street 1:511 E SAN YSIDRO BLVD # 6128
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3150
Mailing Address - Country:US
Mailing Address - Phone:619-250-1703
Mailing Address - Fax:
Practice Address - Street 1:511 E SAN YSIDRO BLVD # 6128
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-3150
Practice Address - Country:US
Practice Address - Phone:619-250-1703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070094332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies