1013926328 NPI number — DYNAMIC MEDICAL SYSTEMS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013926328 NPI number — DYNAMIC MEDICAL SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC MEDICAL SYSTEMS, 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:
1013926328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2811 E ANA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMPTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90221-5601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-225-9080
Provider Business Mailing Address Fax Number:
866-434-3610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3355 MYRTLE AVE
Provider Second Line Business Practice Location Address:
255
Provider Business Practice Location Address City Name:
NORTH HIGHLANDS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95660-5144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-225-9080
Provider Business Practice Location Address Fax Number:
866-434-3610
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
800-225-9080

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  132592 , 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: DME02153F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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