Provider Demographics
NPI:1508399445
Name:PRESTIGE CARE AND MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:PRESTIGE CARE AND MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOMARES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:650-576-0483
Mailing Address - Street 1:2901 S EL CAMINO REAL APT 313
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2782
Mailing Address - Country:US
Mailing Address - Phone:650-576-0483
Mailing Address - Fax:
Practice Address - Street 1:2901 S EL CAMINO REAL APT 313
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2782
Practice Address - Country:US
Practice Address - Phone:650-576-0483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB63179332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies