Provider Demographics
NPI:1306006259
Name:ANAHEIM MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:ANAHEIM MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:IBALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-999-6710
Mailing Address - Street 1:1256 N EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1928
Mailing Address - Country:US
Mailing Address - Phone:714-999-6710
Mailing Address - Fax:714-999-6712
Practice Address - Street 1:1256 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1928
Practice Address - Country:US
Practice Address - Phone:714-999-6710
Practice Address - Fax:714-999-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies