Provider Demographics
NPI:1376990002
Name:MEDWAVE LLC
Entity Type:Organization
Organization Name:MEDWAVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:H
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-842-3595
Mailing Address - Street 1:9505 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-5523
Mailing Address - Country:US
Mailing Address - Phone:562-842-3595
Mailing Address - Fax:562-842-3598
Practice Address - Street 1:9505 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-5523
Practice Address - Country:US
Practice Address - Phone:562-842-3595
Practice Address - Fax:562-842-3598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies