Healthcare Provider Details

I. General information

NPI: 1154369049
Provider Name (Legal Business Name): ALLIED MEDICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 EL CAMINO REAL STE 101
TUSTIN CA
92780-3658
US

IV. Provider business mailing address

170 EL CAMINO REAL STE 101
TUSTIN CA
92780-3658
US

V. Phone/Fax

Practice location:
  • Phone: 714-617-4622
  • Fax: 714-617-4176
Mailing address:
  • Phone: 714-617-4622
  • Fax: 714-617-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number50074
License Number StateCA

VIII. Authorized Official

Name: MS. LIVIA DE LOS RIOS
Title or Position: PRESIDENT
Credential:
Phone: 714-617-4622