Healthcare Provider Details

I. General information

NPI: 1992898647
Provider Name (Legal Business Name): CTR MEDICAL ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3898 CERRITOS AVE
LOS ALAMITOS CA
90720-2420
US

IV. Provider business mailing address

3898 CERRITOS AVE
LOS ALAMITOS CA
90720-2420
US

V. Phone/Fax

Practice location:
  • Phone: 714-826-7890
  • Fax: 714-826-7839
Mailing address:
  • Phone: 714-826-7890
  • Fax: 714-826-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number54666
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number54666
License Number StateCA

VIII. Authorized Official

Name: MR. HAROLD CLIFTON ROSS
Title or Position: OWNER
Credential:
Phone: 714-826-7890