Healthcare Provider Details

I. General information

NPI: 1346478286
Provider Name (Legal Business Name): JT MEDICAL SUPPLY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20980 REDWOOD RD SUITE 260
CASTRO VALLEY CA
94546-5930
US

IV. Provider business mailing address

20980 REDWOOD RD SUITE 260
CASTRO VALLEY CA
94546-5930
US

V. Phone/Fax

Practice location:
  • Phone: 510-300-1330
  • Fax: 510-690-0319
Mailing address:
  • Phone: 510-300-1330
  • Fax: 510-690-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number51010
License Number StateCA

VIII. Authorized Official

Name: MR. MARK RECIO PARINAS
Title or Position: CHAIRMAN AND CEO
Credential: RN PHN
Phone: 510-300-1330