Provider Demographics
NPI:1861500787
Name:WANNAPORN MULLAN
Entity Type:Organization
Organization Name:WANNAPORN MULLAN
Other - Org Name:COALINGA MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANNAPORN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-935-9350
Mailing Address - Street 1:155 SOUTH 5TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-1903
Mailing Address - Country:US
Mailing Address - Phone:559-935-9350
Mailing Address - Fax:559-935-2329
Practice Address - Street 1:155 SOUTH 5TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-1903
Practice Address - Country:US
Practice Address - Phone:559-935-9350
Practice Address - Fax:559-935-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06748ZOtherBLUE SHIELD
CA=========OtherBLUE CROSS
CA4835720001Medicare PIN
CA4835720001Medicare NSC