Healthcare Provider Details

I. General information

NPI: 1013907468
Provider Name (Legal Business Name): MILLBRAE MEDICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 OLD COUNTY RD STE C
BELMONT CA
94002-2500
US

IV. Provider business mailing address

425 OLD COUNTY RD STE C
BELMONT CA
94002-2500
US

V. Phone/Fax

Practice location:
  • Phone: 650-593-2188
  • Fax: 650-593-2044
Mailing address:
  • Phone: 650-593-2188
  • Fax: 650-593-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDME00543F
License Number StateCA

VIII. Authorized Official

Name: MR. OLIVER W FRIEDAUER
Title or Position: PRESIDENT
Credential:
Phone: 650-593-2188