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General NPI Number Information
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NPI Number | 1013045806
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED MEDICAL DISTRIBUTION INC.
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 3035 E PATRICK LN STE # 1
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City | LAS VEGAS
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State | NV
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Zip | 89120-4930
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Country | US
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Telephone | 866-660-0567
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Fax | 866-425-6020
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Provider Business Mailing Address
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Address Line | 3035 E PATRICK LN STE # 1
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City | LAS VEGAS
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State | NV
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Zip | 89120-4930
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Country | US
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Telephone | 866-660-0567
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Fax | 866-425-6020
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Authorized Official
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Title or Position | MANAGER
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Name | MR. RAMEEN RASTINEHAD
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Credential | BSBA
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Telephone | 800-348-6337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | MP00275
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License Number State | NV
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