Healthcare Provider Details

I. General information

NPI: 1376883660
Provider Name (Legal Business Name): WEST COAST DME & SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 CHICAGO AVE. UNIT A
RIVERSIDE CA
92507
US

IV. Provider business mailing address

1835 CHICAGO AVE. UNIT A
RIVERSIDE CA
92507
US

V. Phone/Fax

Practice location:
  • Phone: 909-477-3117
  • Fax: 909-303-9244
Mailing address:
  • Phone: 909-477-3117
  • Fax: 909-303-9244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL GREGORY WELLS
Title or Position: COO
Credential: C.PED
Phone: 909-908-3920