Provider Demographics
NPI:1881202281
Name:PACIFIC MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:PACIFIC MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-287-1271
Mailing Address - Street 1:20101 SW BIRCH ST STE 150M
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1760
Mailing Address - Country:US
Mailing Address - Phone:800-511-5193
Mailing Address - Fax:
Practice Address - Street 1:20101 SW BIRCH ST STE 150M
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1760
Practice Address - Country:US
Practice Address - Phone:800-511-5193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies