MEDICARE: EVERWELL MEDICAL LLC

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

General Provider Information

NPI Number	:	1942186333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERWELL MEDICAL LLC

Provider Business Mailing Address
First Line	:	1111 6TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-5209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 6TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-5209
Country	:	US
Telephone Number	:	305-788-0000
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	FERMON GRAYS
Credential	:
Telephone Number	:	305-788-0000

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	03/13/2026

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Directions to “EVERWELL MEDICAL LLC ” Practice Location

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