Provider Demographics
NPI:1013502848
Name:ALLIED MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:ALLIED MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LOS RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-617-4622
Mailing Address - Street 1:170 EL CAMINO REAL STE 101
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3658
Mailing Address - Country:US
Mailing Address - Phone:714-617-4622
Mailing Address - Fax:
Practice Address - Street 1:9673 SIERRA AVE STE D
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-2424
Practice Address - Country:US
Practice Address - Phone:714-617-6222
Practice Address - Fax:714-617-4176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIED MEDICAL SUPPLY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies