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General NPI Number Information
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NPI Number | 1790922375
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Entity Type | Organization
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Legal Business Name | QUALITY MEDICAL SUPPLY
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Dates
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Enumeration Date | 01/19/2009
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Last Update Date | 01/19/2009
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Provider Practice Location Address
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Address Line | 711 S VERMONT AVE STE 115
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City | LOS ANGELES
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State | CA
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Zip | 90005-1587
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Country | US
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Telephone | 213-384-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 711 S VERMONT AVE STE 115
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City | LOS ANGELES
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State | CA
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Zip | 90005-1587
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Country | US
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Telephone | 213-384-8300
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MARIO MEDINA
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Credential |
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Telephone | 818-406-6499
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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 | 50698
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License Number State | CA
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