Provider Demographics
NPI:1013171255
Name:CALIFORNIA MEDICAL SUPPLY
Entity Type:Organization
Organization Name:CALIFORNIA MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-741-5884
Mailing Address - Street 1:30199 SKIPPERS WAY DR
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-7405
Mailing Address - Country:US
Mailing Address - Phone:951-741-5884
Mailing Address - Fax:
Practice Address - Street 1:30199 SKIPPERS WAY DR
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-7405
Practice Address - Country:US
Practice Address - Phone:951-741-5884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies