Healthcare Provider Details

I. General information

NPI: 1417126780
Provider Name (Legal Business Name): WNC MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 BEACON AVE STE 200
FREMONT CA
94538-1467
US

IV. Provider business mailing address

3705 BEACON AVE STE 200
FREMONT CA
94538-1467
US

V. Phone/Fax

Practice location:
  • Phone: 510-796-5555
  • Fax: 510-796-7044
Mailing address:
  • Phone: 510-796-5555
  • Fax: 510-796-7044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. LOLITA LYDIA SHARP
Title or Position: OWNER
Credential:
Phone: 408-335-8744