Healthcare Provider Details

I. General information

NPI: 1043443369
Provider Name (Legal Business Name): MEDICAL SUPPLY DEPOT 2, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S IMPERIAL AVE SUITE B
CALEXICO CA
92231-3116
US

IV. Provider business mailing address

840 S IMPERIAL AVE SUITE B
CALEXICO CA
92231-3116
US

V. Phone/Fax

Practice location:
  • Phone: 760-768-3172
  • Fax: 760-768-1578
Mailing address:
  • Phone: 760-768-3172
  • Fax: 760-768-1578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: NORBERTO BARROGA
Title or Position: PRESIDENT
Credential:
Phone: 760-768-3172