Healthcare Provider Details

I. General information

NPI: 1396235727
Provider Name (Legal Business Name): MMR DME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 S MAIN AVE
FALLBROOK CA
92028
US

IV. Provider business mailing address

1116 S MAIN AVE
FALLBROOK CA
92028-3325
US

V. Phone/Fax

Practice location:
  • Phone: 760-468-3345
  • Fax:
Mailing address:
  • Phone: 888-293-2175
  • Fax: 760-645-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TROY MONTHEI
Title or Position: OWNER
Credential:
Phone: 888-293-2175