Provider Demographics
NPI:1225680267
Name:RENEW MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:RENEW MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:GULOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-573-1174
Mailing Address - Street 1:14742 NEWPORT AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1612
Mailing Address - Country:US
Mailing Address - Phone:714-714-0555
Mailing Address - Fax:
Practice Address - Street 1:14742 NEWPORT AVE STE 106
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1612
Practice Address - Country:US
Practice Address - Phone:714-714-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies