Provider Demographics
NPI:1477888519
Name:ENGOLOIDS MEDICAL LLC
Entity Type:Organization
Organization Name:ENGOLOIDS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:MONGE
Authorized Official - Last Name:RUFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-687-9208
Mailing Address - Street 1:571 FANELLI CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-1903
Mailing Address - Country:US
Mailing Address - Phone:408-687-9208
Mailing Address - Fax:408-677-3853
Practice Address - Street 1:571 FANELLI CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-1903
Practice Address - Country:US
Practice Address - Phone:408-687-9208
Practice Address - Fax:408-677-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies