Healthcare Provider Details

I. General information

NPI: 1578538583
Provider Name (Legal Business Name): DIVERSIFIED MEDICAL EQUIPMENT & SUPPLIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15472 CHEMICAL LN
HUNTINGTON BEACH CA
92649-1220
US

IV. Provider business mailing address

15472 CHEMICAL LN
HUNTINGTON BEACH CA
92649-1220
US

V. Phone/Fax

Practice location:
  • Phone: 714-657-7610
  • Fax: 714-657-7614
Mailing address:
  • Phone: 714-657-7610
  • Fax: 714-657-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ADRIAN IOJA
Title or Position: GENERAL MANAGER
Credential:
Phone: 714-657-7610