Provider Demographics
NPI:1497003198
Name:WELLNESS MEDICAL EQUIPMENT AND SUPPLIES
Entity Type:Organization
Organization Name:WELLNESS MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:COFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-868-8544
Mailing Address - Street 1:7961 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1848
Mailing Address - Country:US
Mailing Address - Phone:714-868-8544
Mailing Address - Fax:714-868-8546
Practice Address - Street 1:7961 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1848
Practice Address - Country:US
Practice Address - Phone:714-868-8544
Practice Address - Fax:714-868-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56951332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies