Healthcare Provider Details

I. General information

NPI: 1285801753
Provider Name (Legal Business Name): 911 MEDICAL SUPPLY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E 4TH ST SUITE. A2
PERRIS CA
92570-2279
US

IV. Provider business mailing address

305 E 4TH ST SUITE. A2
PERRIS CA
92570-2279
US

V. Phone/Fax

Practice location:
  • Phone: 951-940-9009
  • Fax: 951-940-9005
Mailing address:
  • Phone: 951-940-9009
  • Fax: 951-940-9005

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: AMINA YUSEF-ISMEAL
Title or Position: OWNER/CEO
Credential:
Phone: 951-940-9009