Provider Demographics
NPI:1225190622
Name:POMONA SURGICAL SUPPLY CO.
Entity Type:Organization
Organization Name:POMONA SURGICAL SUPPLY CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HELLIESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-624-5972
Mailing Address - Street 1:885 KENT DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3312
Mailing Address - Country:US
Mailing Address - Phone:909-624-5972
Mailing Address - Fax:
Practice Address - Street 1:733 E HOLT AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5627
Practice Address - Country:US
Practice Address - Phone:909-623-4378
Practice Address - Fax:909-622-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0440460001Medicare UPIN