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General NPI Number Information
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NPI Number | 1730811803
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Entity Type | Organization
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Legal Business Name | ADVANCE DME AND MEDICAL SUPPLIES, LLC
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 670 SOUTH JEFFERSON ST,, STE. A
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City | PLACENTIA
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State | CA
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Zip | 92870
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Country | US
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Telephone | 833-693-6393
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Fax | 657-216-2809
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Provider Business Mailing Address
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Address Line | 670 SOUTH JEFFERSON ST., STE. A
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City | PLACENTIA
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State | CA
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Zip | 92870
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Country | US
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Telephone | 833-693-6393
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Fax | 657-216-2809
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Authorized Official
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Title or Position | CEO
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Name | MATTHEW VINCENT MONAHAN
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Credential |
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Telephone | 562-640-1161
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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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