Healthcare Provider Details

I. General information

NPI: 1659160034
Provider Name (Legal Business Name): ATLAS MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 B ST STE 1570
SAN DIEGO CA
92101-8153
US

IV. Provider business mailing address

701 B ST STE 1570
SAN DIEGO CA
92101-8153
US

V. Phone/Fax

Practice location:
  • Phone: 951-380-2181
  • Fax:
Mailing address:
  • Phone: 951-380-2181
  • 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 Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: SABRA QASSIMYAR
Title or Position: MANAGING PARTNER
Credential:
Phone: 858-232-0554