Provider Demographics
NPI:1205824521
Name:DAMAR MEDICAL INDUSTRIES INC
Entity Type:Organization
Organization Name:DAMAR MEDICAL INDUSTRIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:562-803-6636
Mailing Address - Street 1:12460 BELLFLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2806
Mailing Address - Country:US
Mailing Address - Phone:562-803-6636
Mailing Address - Fax:562-803-4709
Practice Address - Street 1:12460 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2806
Practice Address - Country:US
Practice Address - Phone:562-803-6636
Practice Address - Fax:562-803-4709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXC0004720Medicaid
CAXC0004720Medicaid