Provider Demographics
NPI:1801183272
Name:DELUXE MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:DELUXE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:YERKEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TENIZBAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-741-5901
Mailing Address - Street 1:7474 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7420
Mailing Address - Country:US
Mailing Address - Phone:619-741-5901
Mailing Address - Fax:619-741-5910
Practice Address - Street 1:7474 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7420
Practice Address - Country:US
Practice Address - Phone:619-741-5901
Practice Address - Fax:619-741-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6612630001Medicare NSC