Healthcare Provider Details

I. General information

NPI: 1477928836
Provider Name (Legal Business Name): AVENUE MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 TIGER RUN CT SUITE 118
CARLSBAD CA
92010-6692
US

IV. Provider business mailing address

3142 TIGER RUN CT SUITE 118
CARLSBAD CA
92010-6692
US

V. Phone/Fax

Practice location:
  • Phone: 760-978-6060
  • Fax:
Mailing address:
  • Phone: 760-978-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateCA

VIII. Authorized Official

Name: MYO TUN
Title or Position: CEO/OWNER
Credential:
Phone: 949-680-7444