Healthcare Provider Details

I. General information

NPI: 1427369909
Provider Name (Legal Business Name): V & J MEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8330 LONG BEACH BLVD SUITE 112
SOUTH GATE CA
90280-2073
US

IV. Provider business mailing address

8330 LONG BEACH BLVD SUITE 112
SOUTH GATE CA
90280-2073
US

V. Phone/Fax

Practice location:
  • Phone: 323-947-7547
  • Fax: 323-973-1733
Mailing address:
  • Phone: 323-947-7547
  • Fax: 323-973-1733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MANUEL SALVADOR MEDINA JR.
Title or Position: OWNER
Credential:
Phone: 323-947-7547