Healthcare Provider Details

I. General information

NPI: 1194863811
Provider Name (Legal Business Name): F & R MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14465 MAIN ST SUITE 4
HESPERIA CA
92345-4699
US

IV. Provider business mailing address

14465 MAIN ST SUITE 4
HESPERIA CA
92345-4699
US

V. Phone/Fax

Practice location:
  • Phone: 760-956-9930
  • Fax: 760-956-9931
Mailing address:
  • Phone: 760-956-9930
  • Fax: 760-956-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number46544
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANCIS ONNEKIKAMI
Title or Position: OWNER
Credential:
Phone: 760-956-9930