Provider Demographics
NPI:1891067856
Name:SB MEDICAL
Entity Type:Organization
Organization Name:SB MEDICAL
Other - Org Name:STOMABAGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-600-4421
Mailing Address - Street 1:1440C 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1336
Mailing Address - Country:US
Mailing Address - Phone:305-600-4421
Mailing Address - Fax:305-517-3817
Practice Address - Street 1:1440C 4TH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1336
Practice Address - Country:US
Practice Address - Phone:305-600-4421
Practice Address - Fax:305-517-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies