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General NPI Number Information
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NPI Number | 1811131816
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Entity Type | Organization
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Legal Business Name | SMART DME AND SUPPLIES, INC
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 18701 PARTHENIA ST STE 3
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City | NORTHRIDGE
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State | CA
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Zip | 91324-3814
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Country | US
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Telephone | 818-324-0019
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Fax | 818-772-9685
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Provider Business Mailing Address
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Address Line | 18701 PARTHENIA ST STE 3
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City | NORTHRIDGE
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State | CA
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Zip | 91324-3814
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Country | US
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Telephone | 818-324-0019
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Fax | 818-772-9685
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. AMANTEFLOR PERCIVAL VILLANUEVA
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Credential |
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Telephone | 818-324-0019
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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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