Provider Demographics
NPI:1467621615
Name:MEDICAL SUPPLIES IHP, INC
Entity Type:Organization
Organization Name:MEDICAL SUPPLIES IHP, INC
Other - Org Name:MEDICAL SUPPLIES IHP, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIROZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-517-2995
Mailing Address - Street 1:530 W LOS ANGELES AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1746
Mailing Address - Country:US
Mailing Address - Phone:805-517-2995
Mailing Address - Fax:805-517-1237
Practice Address - Street 1:530 W LOS ANGELES AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1746
Practice Address - Country:US
Practice Address - Phone:805-517-2995
Practice Address - Fax:805-517-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23019OtherHMDR EXEMPTEE
CA1467621615Medicaid
CA57836OtherHMDR