Provider Demographics
NPI:1518993625
Name:HS MEDICAL INC
Entity Type:Organization
Organization Name:HS MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GONZALO
Authorized Official - Middle Name:ALMONTE
Authorized Official - Last Name:SANTA MARIA
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:909-370-3979
Mailing Address - Street 1:PO BOX 2118
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-0823
Mailing Address - Country:US
Mailing Address - Phone:909-370-3979
Mailing Address - Fax:909-370-3923
Practice Address - Street 1:671 S COOLEY DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-370-3979
Practice Address - Fax:909-370-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44848332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66608ZOtherBLUE SHIELD OF CALIFORNIA
CA=========OtherMOLINA HEALTHCARE
CA5597470001Medicare NSC