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General NPI Number Information
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NPI Number | 1154755148
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Entity Type | Organization
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Legal Business Name | MEDICAL SUPPLIES IHP
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Dates
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Enumeration Date | 08/26/2013
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 530 NEW LOS ANGELES AVE STE 117
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City | MOORPARK
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State | CA
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Zip | 93021-2081
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Country | US
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Telephone | 805-517-2995
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Fax | 805-517-1237
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Provider Business Mailing Address
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Address Line | 530 NEW LOS ANGELES AVE STE 117
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City | MOORPARK
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State | CA
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Zip | 93021-2081
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Country | US
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Telephone | 805-517-2995
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Fax | 805-517-1237
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID QUIROZ
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Credential | MBA
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Telephone | 805-517-2995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 57836
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License Number State | CA
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