Healthcare Provider Details

I. General information

NPI: 1780905992
Provider Name (Legal Business Name): 9TH ST MEDICAL SUPPLY & EQUIPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38346 9TH ST E
PALMDALE CA
93550-4723
US

IV. Provider business mailing address

38346 9TH ST E
PALMDALE CA
93550-4723
US

V. Phone/Fax

Practice location:
  • Phone: 818-471-3544
  • Fax:
Mailing address:
  • Phone:
  • 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: DEVON JORDAN
Title or Position: OWNER
Credential:
Phone: 818-471-3544