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General NPI Number Information
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NPI Number | 1881825008
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Entity Type | Organization
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Legal Business Name | MISSION MEDICAL SUPPLY
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 4444 EL CAJON BLVD 03
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City | SAN DIEGO
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State | CA
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Zip | 92115-4312
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Country | US
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Telephone | 619-229-9597
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Fax | 619-229-9594
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Provider Business Mailing Address
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Address Line | 4444 EL CAJON BLVD 03
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City | SAN DIEGO
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State | CA
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Zip | 92115-4312
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Country | US
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Telephone | 619-229-9597
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Fax | 619-229-9594
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Authorized Official
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Title or Position | OWNER
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Name | MS. MIMI DO
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Credential |
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Telephone | 619-229-9597
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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 | 200901610039
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License Number State | CA
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