Provider Demographics
NPI:1790327732
Name:TRIUMPH SPECIALTIES LLC
Entity Type:Organization
Organization Name:TRIUMPH SPECIALTIES LLC
Other - Org Name:TRIUMPH SPECIALTIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBALCAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-499-5577
Mailing Address - Street 1:11100 SEPULVEDA BLVD # 8-519
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1131
Mailing Address - Country:US
Mailing Address - Phone:888-499-5577
Mailing Address - Fax:888-499-5577
Practice Address - Street 1:11100 SEPULVEDA BLVD # 8-519
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1131
Practice Address - Country:US
Practice Address - Phone:888-499-5577
Practice Address - Fax:888-499-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site