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General NPI Number Information
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NPI Number | 1194972240
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Entity Type | Organization
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Legal Business Name | EXPRESS MEDICAL SUPPLY
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 3065 N RANCHO DR SUITE 152
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City | LAS VEGAS
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State | NV
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Zip | 89130-3352
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Country | US
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Telephone | 702-656-8312
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Fax | 702-656-1579
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Provider Business Mailing Address
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Address Line | 1254 LINDSAY ST
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City | CHULA VISTA
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State | CA
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Zip | 91913-1431
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Country | US
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Telephone | 619-423-2600
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Fax | 619-423-2681
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDUARDO MAGLONCIO DEOCAMPO
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Credential |
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Telephone | 702-656-8312
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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 | MP00551
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License Number State | NV
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