Provider Demographics
NPI:1538466024
Name:AEROMEDIC HEALTHCARE INC.
Entity Type:Organization
Organization Name:AEROMEDIC HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:REVILLA
Authorized Official - Last Name:PASCUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-592-6400
Mailing Address - Street 1:425 W ALLEN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1485
Mailing Address - Country:US
Mailing Address - Phone:909-592-6400
Mailing Address - Fax:
Practice Address - Street 1:425 W ALLEN AVE STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1485
Practice Address - Country:US
Practice Address - Phone:909-592-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54904332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6527650001Medicare PIN
CA6527650001Medicare NSC