=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972263580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STABILITY MEDICAL EQUIPMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2021
-----------------------------------------------------
Last Update Date | 03/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 THIRD AVE STE 311
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91911-1310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-732-3060
-----------------------------------------------------
Fax | 844-288-8144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 THIRD AVE STE 311
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91911-1310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-732-3060
-----------------------------------------------------
Fax | 844-288-8144
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O.
-----------------------------------------------------
Name | MR. FERNANDO VALENZUELA-VALDES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-732-3060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------