Provider Demographics
NPI:1679976393
Name:SYNERGY DMEPOS
Entity type:Organization
Organization Name:SYNERGY DMEPOS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-203-9810
Mailing Address - Street 1:48521 WARM SPRINGS BLVD STE 317
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7792
Mailing Address - Country:US
Mailing Address - Phone:866-203-9810
Mailing Address - Fax:855-230-1468
Practice Address - Street 1:48521 WARM SPRINGS BLVD STE 317
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7792
Practice Address - Country:US
Practice Address - Phone:510-770-9010
Practice Address - Fax:855-230-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0194020002Medicare UPIN