MEDICARE: MEDTECH MEDICAL SUPPLY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	49380	CA

General Provider Information

NPI Number	:	1033325667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDTECH MEDICAL SUPPLY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 2098
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91769-2098
Country	:	US
Telephone Number	:	626-962-7580
Fax Number	:	626-960-1659

Provider Business Practice Location Address
First Line	:	1331 W GARVEY AVE N
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-2242
Country	:	US
Telephone Number	:	626-962-7580
Fax Number	:	626-960-1659

Authorized Official
Title or Position	:	MEMBER
Name	:	OLAWALE AYOOLA OYETIBO
Credential	:
Telephone Number	:	626-962-7580

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	05/06/2009

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