Provider Demographics
NPI:1225509912
Name:RANCHO BERNARDO MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:RANCHO BERNARDO MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DADAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-331-6003
Mailing Address - Street 1:16766 BERNARDO CENTER DR STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2501
Mailing Address - Country:US
Mailing Address - Phone:858-924-8489
Mailing Address - Fax:
Practice Address - Street 1:16766 BERNARDO CENTER DR STE 104
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2501
Practice Address - Country:US
Practice Address - Phone:858-943-4812
Practice Address - Fax:858-924-8489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies