1255998290 NPI number — WEST COAST DME & SUPPLIES LLC

Table of content: (NPI 1255998290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255998290 NPI number — WEST COAST DME & SUPPLIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST COAST DME & SUPPLIES LLC
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:
1255998290
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1835 CHICAGO AVE STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92507-2309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-477-3117
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8322 CLAIREMONT MESA BLVD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-477-3117
Provider Business Practice Location Address Fax Number:
909-303-9244
Provider Enumeration Date:
05/24/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WELLS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
GREGORY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-908-3920

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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