Healthcare Provider Details

I. General information

NPI: 1699163741
Provider Name (Legal Business Name): ALL SEASONS MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E AVENUE S SUITE B
PALMDALE CA
93550-6196
US

IV. Provider business mailing address

1220 E AVENUE S SUITE B
PALMDALE CA
93550-6196
US

V. Phone/Fax

Practice location:
  • Phone: 877-252-4363
  • Fax:
Mailing address:
  • Phone: 877-252-4363
  • 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: MR. JAMES ROBERT TELLES JR.
Title or Position: CEO
Credential:
Phone: 805-844-8235