Healthcare Provider Details

I. General information

NPI: 1205834892
Provider Name (Legal Business Name): LA PALOMA MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 E GRANT ST
ROMA TX
78584-8755
US

IV. Provider business mailing address

PO BOX 1144
ROMA TX
78584-1144
US

V. Phone/Fax

Practice location:
  • Phone: 956-849-5586
  • Fax:
Mailing address:
  • Phone: 956-849-5586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUAN GARCIA
Title or Position: OWNER
Credential:
Phone: 956-849-5586