Provider Demographics
NPI:1144407065
Name:HEALTH AMERICA MEDICAL EQUIPMENTS & SUPPLY INC.
Entity Type:Organization
Organization Name:HEALTH AMERICA MEDICAL EQUIPMENTS & SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:ONNEKIKAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-824-6709
Mailing Address - Street 1:16039 WALNUT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3478
Mailing Address - Country:US
Mailing Address - Phone:760-947-9667
Mailing Address - Fax:866-243-2835
Practice Address - Street 1:16039 WALNUT ST
Practice Address - Street 2:SUITE A
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3478
Practice Address - Country:US
Practice Address - Phone:760-947-9667
Practice Address - Fax:866-243-2835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48771332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6065580001Medicare NSC