Provider Demographics
NPI:1336473206
Name:TRIANA MEDICAL SUPPLY
Entity Type:Organization
Organization Name:TRIANA MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:ILEANA
Authorized Official - Last Name:ATALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:619-713-6800
Mailing Address - Street 1:3855 AVOCADO BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7382
Mailing Address - Country:US
Mailing Address - Phone:619-713-6800
Mailing Address - Fax:619-639-0376
Practice Address - Street 1:3855 AVOCADO BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7382
Practice Address - Country:US
Practice Address - Phone:619-713-6800
Practice Address - Fax:619-639-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51406332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies