MEDICARE: ADVANCE 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	52149	CA

General Provider Information

NPI Number	:	1952315608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	7771 UNIVERSITY AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-4950
Country	:	US
Telephone Number	:	619-466-9255
Fax Number	:	619-466-9254

Provider Business Practice Location Address
First Line	:	7771 UNIVERSITY AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-4950
Country	:	US
Telephone Number	:	619-466-9255
Fax Number	:	619-466-9254

Authorized Official
Title or Position	:	P
Name	:	AZHER A HADDAWI
Credential	:
Telephone Number	:	619-466-9255

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	04/10/2012

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