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General NPI Number Information
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NPI Number | 1972527539
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Entity Type | Organization
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Legal Business Name | KLUK MEDICAL SUPPLIES INC
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3229 KLUK LN STE 105
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City | RIVERSIDE
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State | CA
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Zip | 92501-1100
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Country | US
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Telephone | 909-238-3115
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Fax |
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Provider Business Mailing Address
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Address Line | 3229 KLUK LN STE 105
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City | RIVERSIDE
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State | CA
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Zip | 92501-1100
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Country | US
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Telephone | 909-238-3115
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. BERLINDA PHOMMALAYVANE
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Credential |
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Telephone | 909-238-3115
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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 | CA
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