Provider Demographics
NPI:1972660645
Name:TITAN MEDICAL DME, INC.
Entity Type:Organization
Organization Name:TITAN MEDICAL DME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABATAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-578-4826
Mailing Address - Street 1:PO BOX 7746
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91359-7746
Mailing Address - Country:US
Mailing Address - Phone:888-578-4826
Mailing Address - Fax:888-318-4826
Practice Address - Street 1:803 CAMARILLO SPRINGS RD
Practice Address - Street 2:SUITE A
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-9459
Practice Address - Country:US
Practice Address - Phone:888-578-4826
Practice Address - Fax:888-318-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7041750001Medicare NSC