Healthcare Provider Details

I. General information

NPI: 1578008371
Provider Name (Legal Business Name): STAR MEDICAL EQUIPMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 STERLING AVE STE H
RIVERSIDE CA
92503-4973
US

IV. Provider business mailing address

11711 STERLING AVE STE H
RIVERSIDE CA
92503-4973
US

V. Phone/Fax

Practice location:
  • Phone: 951-772-0533
  • Fax:
Mailing address:
  • Phone: 951-772-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number95480
License Number StateCA

VIII. Authorized Official

Name: BARLYNN TUCKER
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 213-200-1558