Provider Demographics
NPI:1346787108
Name:SAN JOAQUIN MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:SAN JOAQUIN MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-334-8790
Mailing Address - Street 1:10810 AVENUE 184
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-9514
Mailing Address - Country:US
Mailing Address - Phone:559-334-8790
Mailing Address - Fax:
Practice Address - Street 1:10810 AVENUE 184
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-9514
Practice Address - Country:US
Practice Address - Phone:559-334-8790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies