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General NPI Number Information
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NPI Number | 1639975113
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Entity Type | Organization
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Legal Business Name | PACIFIC HEALTH SUPPLY LLC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 4225 EXECUTIVE SQ STE 600
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City | LA JOLLA
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State | CA
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Zip | 92037-1484
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Country | US
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Telephone | 858-222-3560
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Fax |
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Provider Business Mailing Address
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Address Line | 4225 EXECUTIVE SQ STE 600
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City | LA JOLLA
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State | CA
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Zip | 92037-1484
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Country | US
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Telephone | 858-222-3560
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAAD ABDRABOU ABDELRA METWALLY
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Credential |
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Telephone | 858-222-3560
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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 |
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License Number State |
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