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General NPI Number Information
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NPI Number | 1770433898
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Entity Type | Organization
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Legal Business Name | B LACED MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 01/29/2026
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 1528 SHIRLEY AVE
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City | MANTECA
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State | CA
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Zip | 95337
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Country | US
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Telephone | 209-972-0340
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Fax |
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Provider Business Mailing Address
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Address Line | 249 COMMERCE AVE # 1057
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City | MANTECA
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State | CA
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Zip | 95336-5061
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Country | US
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Telephone | 209-972-0340
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DEOZENE STONE
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Credential |
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Telephone | 209-972-0340
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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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