Provider Demographics
NPI:1710585161
Name:INTERLANG LLC DBA MONTGOMERY DME
Entity Type:Organization
Organization Name:INTERLANG LLC DBA MONTGOMERY DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:626-660-8924
Mailing Address - Street 1:14109 PONTLAVOY AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-4934
Mailing Address - Country:US
Mailing Address - Phone:562-777-7088
Mailing Address - Fax:
Practice Address - Street 1:14109 PONTLAVOY AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE SPGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4934
Practice Address - Country:US
Practice Address - Phone:562-777-7088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies