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General NPI Number Information
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NPI Number | 1366597858
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Entity Type | Organization
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Legal Business Name | GALLANT MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 162 N SAN JACINTO ST
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City | HEMET
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State | CA
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Zip | 92543-4450
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Country | US
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Telephone | 951-658-2505
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Fax | 951-658-2460
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Provider Business Mailing Address
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Address Line | 27740 ENCANTO DR
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City | SUN CITY
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State | CA
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Zip | 92586-4521
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Country | US
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Telephone | 951-672-4965
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Fax | 951-672-4966
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Authorized Official
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Title or Position | CEO
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Name | MR. YOUNG DENNIS AHN
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Credential |
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Telephone | 951-672-4965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | PENDING
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License Number State | CA
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