Provider Demographics
NPI:1164694238
Name:EAST BAY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:EAST BAY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:ABLAY
Authorized Official - Last Name:SAUCELO
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:925-783-4059
Mailing Address - Street 1:5421 LONE TREE WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5380
Mailing Address - Country:US
Mailing Address - Phone:925-783-4059
Mailing Address - Fax:800-886-8651
Practice Address - Street 1:5421 LONE TREE WAY STE 150
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5380
Practice Address - Country:US
Practice Address - Phone:925-783-4059
Practice Address - Fax:800-886-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-29
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48468332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies