Provider Demographics
NPI:1477928836
Name:AVENUE MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:AVENUE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYO
Authorized Official - Middle Name:
Authorized Official - Last Name:TUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-680-7444
Mailing Address - Street 1:3142 TIGER RUN CT
Mailing Address - Street 2:SUITE 118
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-6692
Mailing Address - Country:US
Mailing Address - Phone:760-978-6060
Mailing Address - Fax:
Practice Address - Street 1:3142 TIGER RUN CT
Practice Address - Street 2:SUITE 118
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6692
Practice Address - Country:US
Practice Address - Phone:760-978-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X, 332BN1400X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies