Provider Demographics
NPI:1740740257
Name:SWEETWATER MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:SWEETWATER MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARAMIS
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:VELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-937-3990
Mailing Address - Street 1:124 E 30TH ST STE A4
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7332
Mailing Address - Country:US
Mailing Address - Phone:619-937-3990
Mailing Address - Fax:619-383-2300
Practice Address - Street 1:124 E 30TH ST STE A4
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7332
Practice Address - Country:US
Practice Address - Phone:619-937-3990
Practice Address - Fax:619-383-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies