Healthcare Provider Details

I. General information

NPI: 1558826628
Provider Name (Legal Business Name): SML MEDICAL SUPPLIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 E MIRALOMA AVE STE 117
ANAHEIM CA
92806-1924
US

IV. Provider business mailing address

3315 E MIRALOMA AVE STE 117
ANAHEIM CA
92806-1924
US

V. Phone/Fax

Practice location:
  • Phone: 909-559-7200
  • Fax: 909-393-1438
Mailing address:
  • Phone: 909-559-7200
  • Fax: 909-393-1438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMEH AWAD
Title or Position: PRESIDENT
Credential:
Phone: 909-559-7200