Healthcare Provider Details

I. General information

NPI: 1790366904
Provider Name (Legal Business Name): ABLE MEDICAL SUPPLY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13373 PERRIS BLVD STE E411
MORENO VALLEY CA
92553-5410
US

IV. Provider business mailing address

13373 PERRIS BLVD STE E411
MORENO VALLEY CA
92553-5410
US

V. Phone/Fax

Practice location:
  • Phone: 951-348-7878
  • Fax:
Mailing address:
  • Phone: 951-348-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FRESHTA SHALIKAR
Title or Position: OWNER
Credential:
Phone: 951-348-7878