Provider Demographics
NPI:1164456190
Name:SAN DIEGO AIR SUPPORT INC
Entity Type:Organization
Organization Name:SAN DIEGO AIR SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-587-2700
Mailing Address - Street 1:9540 WAPLES ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2970
Mailing Address - Country:US
Mailing Address - Phone:858-587-2700
Mailing Address - Fax:858-587-2727
Practice Address - Street 1:9540 WAPLES ST
Practice Address - Street 2:SUITE H
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2970
Practice Address - Country:US
Practice Address - Phone:858-587-2700
Practice Address - Fax:858-587-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01697FMedicaid
CA0154120001Medicare NSC