1073750949 NPI number — SUPERIOR MED SURGICAL, INC.

Table of content: (NPI 1073750949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073750949 NPI number — SUPERIOR MED SURGICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPERIOR MED SURGICAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073750949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 N MOUNTAIN AVE
Provider Second Line Business Mailing Address:
#201
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-980-0065
Provider Business Mailing Address Fax Number:
909-980-0303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9445 FAIRWAY VIEW PL.
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-980-0065
Provider Business Practice Location Address Fax Number:
909-980-0303
Provider Enumeration Date:
01/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
AMORANTO
Authorized Official First Name:
CARMELITA
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
OPERATION MANAGER
Authorized Official Telephone Number:
909-980-0065

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  N/A ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: HMDR LICENSE # 51915 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51915 . This is a "HMDR LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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