MEDICARE: 24HR MEDICAL SUPPLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	00030975	CA

General Provider Information

NPI Number	:	1164793915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	24HR MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	1036 ARENA CIR
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-3177
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1036 ARENA CIR
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-3177
Country	:	US
Telephone Number	:	760-201-6564
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARISA LYN MAYLE
Credential	:
Telephone Number	:	760-201-6564

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	01/24/2012

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