Healthcare Provider Details

I. General information

NPI: 1285559476
Provider Name (Legal Business Name): MOUNTAINCREST DURABLES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9121 DARWIN RD PHELAN, CA 92371
PHELAN CA
92371
US

IV. Provider business mailing address

9121 DARWIN RD PHELAN, CA 92371
PHELAN CA
92371
US

V. Phone/Fax

Practice location:
  • Phone: 213-800-9815
  • Fax:
Mailing address:
  • Phone: 213-800-9815
  • 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: DARRYL JOHNSON
Title or Position: OWNER
Credential:
Phone: 213-800-9815