Healthcare Provider Details

I. General information

NPI: 1134850696
Provider Name (Legal Business Name): ADVANCE DME AND MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 S JEFFERSON ST STE A
PLACENTIA CA
92870-6638
US

IV. Provider business mailing address

670 S JEFFERSON ST STE A
PLACENTIA CA
92870-6638
US

V. Phone/Fax

Practice location:
  • Phone: 833-693-6393
  • Fax:
Mailing address:
  • Phone: 833-693-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CINDY JOHNSON MONAHAN
Title or Position: PRESIDENT
Credential:
Phone: 562-631-3316