Healthcare Provider Details

I. General information

NPI: 1205773496
Provider Name (Legal Business Name): MEDUVO RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 FOOTHILL BLVD
LA VERNE CA
91750-3027
US

IV. Provider business mailing address

2353 FOOTHILL BLVD
LA VERNE CA
91750-3027
US

V. Phone/Fax

Practice location:
  • Phone: 888-633-8867
  • Fax:
Mailing address:
  • Phone: 888-633-8867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARIO TABRAUE
Title or Position: MANAGER
Credential:
Phone: 786-295-1084