Provider Demographics
NPI:1689819443
Name:SEMAJO MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:SEMAJO MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOSUNMOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AYOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-881-7765
Mailing Address - Street 1:248 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3703
Mailing Address - Country:US
Mailing Address - Phone:909-881-7765
Mailing Address - Fax:909-881-7767
Practice Address - Street 1:248 E HIGHLAND AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3703
Practice Address - Country:US
Practice Address - Phone:909-881-7765
Practice Address - Fax:909-881-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50452332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6350340001Medicare NSC