1740316785 NPI number — SEA BREEZE MEDICAL SUPPLY 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 1740316785 NPI number — SEA BREEZE MEDICAL SUPPLY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEA BREEZE MEDICAL SUPPLY 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:
1740316785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1926 S PACIFIC COAST HWY
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
REDONDO BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90277-6119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-944-3200
Provider Business Mailing Address Fax Number:
310-944-9970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1926 S PACIFIC COAST HWY
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
REDONDO BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90277-6119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-944-3200
Provider Business Practice Location Address Fax Number:
310-944-9970
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PALACIOS
Authorized Official First Name:
ALFONSO
Authorized Official Middle Name:
FRANCISCO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-944-3200

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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