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NPI Code Detail

MEDICARE: ABIGAIL'S MEDICAL SUPPLY INC

MEDICARE: ABIGAIL'S MEDICAL SUPPLY INC
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
1224900000XMastectomy Fitter

General Provider Information

NPI Number : 1053944827
Entity Type Code : Organization
Provider Name (Legal Business Name) : ABIGAIL'S MEDICAL SUPPLY INC
Provider Business Mailing Address
First Line : 2020 CAMINO DEL RIO N STE 105
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1542
Country : US
Telephone Number : 760-940-1132
Fax Number : 760-940-1134
Provider Business Practice Location Address
First Line : 2020 CAMINO DEL RIO N STE 105
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1542
Country : US
Telephone Number : 760-940-1132
Fax Number : 760-940-1134
Authorized Official
Title or Position : CEO
Name : ABIGAIL JONES NEWSOME
Credential :
Telephone Number : 760-940-1132
Provider Enumeration Date : 02/19/2020
Last Update Date : 02/19/2020

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Directions to “ABIGAIL'S MEDICAL SUPPLY INC ” Practice Location

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