Healthcare Provider Details

I. General information

NPI: 1356521678
Provider Name (Legal Business Name): AEON MEDICAL EQUIPMENT & SUPPLIES, INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 MCKINLEY AVE STE B
LA VERNE CA
91750-5800
US

IV. Provider business mailing address

1925 MCKINLEY AVE STE B
LA VERNE CA
91750-5800
US

V. Phone/Fax

Practice location:
  • Phone: 909-596-3252
  • Fax: 909-596-3301
Mailing address:
  • Phone: 909-596-3252
  • Fax: 909-596-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number07 00005902
License Number StateCA

VIII. Authorized Official

Name: OMAR TOLENTINO
Title or Position: CEO
Credential:
Phone: 909-596-3252