Healthcare Provider Details

I. General information

NPI: 1801183272
Provider Name (Legal Business Name): DELUXE MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7474 EL CAJON BLVD
LA MESA CA
91942-7420
US

IV. Provider business mailing address

7474 EL CAJON BLVD
LA MESA CA
91942-7420
US

V. Phone/Fax

Practice location:
  • Phone: 619-741-5901
  • Fax: 619-741-5910
Mailing address:
  • Phone: 619-741-5901
  • Fax: 619-741-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. YERKEN TENIZBAYEV
Title or Position: CEO
Credential:
Phone: 619-741-5901