Healthcare Provider Details

I. General information

NPI: 1912855180
Provider Name (Legal Business Name): SUMMIT MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 S MANHATTAN PL APT 306
LOS ANGELES CA
90005-3375
US

IV. Provider business mailing address

632 SPEER CT
POMONA CA
91766-6144
US

V. Phone/Fax

Practice location:
  • Phone: 601-907-3796
  • Fax:
Mailing address:
  • Phone: 601-907-3796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CHAUDHRY MUHAMMAD A WALANA
Title or Position: CEO
Credential:
Phone: 601-907-3796