Provider Demographics
NPI:1518467273
Name:MINERVA MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:MINERVA MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:NASSIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ESSAYLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-845-4493
Mailing Address - Street 1:22865 RIDGE ROUTE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3675
Mailing Address - Country:US
Mailing Address - Phone:800-845-4493
Mailing Address - Fax:949-340-0086
Practice Address - Street 1:22865 RIDGE ROUTE LN
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3675
Practice Address - Country:US
Practice Address - Phone:800-845-4493
Practice Address - Fax:949-340-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies