Provider Demographics
NPI:1134614274
Name:ON THE GO MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:ON THE GO MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAWAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-552-4075
Mailing Address - Street 1:12421 HESPERIA RD STE 1
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7704
Mailing Address - Country:US
Mailing Address - Phone:760-552-4075
Mailing Address - Fax:760-552-4023
Practice Address - Street 1:12421 HESPERIA RD STE 1
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7704
Practice Address - Country:US
Practice Address - Phone:760-552-4075
Practice Address - Fax:760-552-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BX2000X
CA98950332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies