Provider Demographics
NPI:1003620683
Name:DELUXE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:DELUXE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YERKEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TENIZBAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-741-5901
Mailing Address - Street 1:7474 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7420
Mailing Address - Country:US
Mailing Address - Phone:619-741-5901
Mailing Address - Fax:619-741-5910
Practice Address - Street 1:4240 LATHAM ST STE E
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1741
Practice Address - Country:US
Practice Address - Phone:619-741-5901
Practice Address - Fax:619-741-5910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELUXE MEDICAL SUPPLY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-04
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies