Provider Demographics
NPI:1972643245
Name:T & T CARE PLUS MEDICAL SUPPLY SERVICES INC
Entity Type:Organization
Organization Name:T & T CARE PLUS MEDICAL SUPPLY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAJUDEEN
Authorized Official - Middle Name:LAT
Authorized Official - Last Name:AJAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-514-8889
Mailing Address - Street 1:2235 S PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-5933
Mailing Address - Country:US
Mailing Address - Phone:310-514-8889
Mailing Address - Fax:310-514-8885
Practice Address - Street 1:2235 S PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-5933
Practice Address - Country:US
Practice Address - Phone:310-514-8889
Practice Address - Fax:310-514-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46594332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5891190001Medicare NSC