Provider Demographics
NPI:1710446158
Name:EXPRESS MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:EXPRESS MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELAHE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEJAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-201-9700
Mailing Address - Street 1:26413 JEFFERSON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6979
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26413 JEFFERSON AVE STE D
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-6979
Practice Address - Country:US
Practice Address - Phone:833-201-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies