Healthcare Provider Details

I. General information

NPI: 1033118609
Provider Name (Legal Business Name): PROMED DME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10641 CALLE LEE #185
LOS ALAMITOS CA
90720-2567
US

IV. Provider business mailing address

10641 CALLE LEE #185
LOS ALAMITOS CA
90720-2567
US

V. Phone/Fax

Practice location:
  • Phone: 714-816-7888
  • Fax: 714-816-7898
Mailing address:
  • Phone: 714-816-7888
  • Fax: 714-816-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number332BX2000X
License Number StateCA

VIII. Authorized Official

Name: MR. RICH V. KING
Title or Position: CEO/PRES
Credential:
Phone: 714-816-7888