MEDICARE: MEDTECH MEDICAL SUPPLY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DME03096F	OTHER	CA	MEDICAL-CROSSOVER

General Provider Information

NPI Number	:	1073578514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDTECH MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	PO BOX 2098
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91769-2098
Country	:	US
Telephone Number	:	909-948-5895
Fax Number	:

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	:	OFFICER
Name	:	MR. OLAWALE AYOOLA OYETIBO
Credential	:
Telephone Number	:	626-962-7580

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	02/05/2009

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Directions to “MEDTECH MEDICAL SUPPLY ” Practice Location

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