Provider Demographics
NPI:1376271403
Name:MEDPLUS DME
Entity Type:Organization
Organization Name:MEDPLUS DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DY BUCO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:714-770-0144
Mailing Address - Street 1:1501 S RAYMOND AVENUE SUITE K
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:714-770-0144
Mailing Address - Fax:714-770-0134
Practice Address - Street 1:1501 S RAYMOND AVENUE SUITE K
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-770-0144
Practice Address - Fax:714-770-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA116463OtherDEPARTMENT OF PUBLIC HEALTH FOOD AND DRUG BRANCH