Provider Demographics
NPI:1245570357
Name:LEMON GROVE MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:LEMON GROVE MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUFYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-335-3658
Mailing Address - Street 1:7737 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945
Mailing Address - Country:US
Mailing Address - Phone:619-335-3658
Mailing Address - Fax:
Practice Address - Street 1:7737 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1740
Practice Address - Country:US
Practice Address - Phone:619-335-3658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies