Provider Demographics
NPI:1598050338
Name:360 MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:360 MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:MARLON
Authorized Official - Last Name:CABATINGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-360-0288
Mailing Address - Street 1:828 SAN PABLO AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2229
Mailing Address - Country:US
Mailing Address - Phone:888-360-0288
Mailing Address - Fax:888-360-0288
Practice Address - Street 1:828 SAN PABLO AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2229
Practice Address - Country:US
Practice Address - Phone:888-360-0288
Practice Address - Fax:888-360-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies