Provider Demographics
NPI:1295733947
Name:ASHLEY MEDICAL, INC
Entity type:Organization
Organization Name:ASHLEY MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, RCP
Authorized Official - Phone:619-297-1983
Mailing Address - Street 1:1010 UNIVERSITY AVE
Mailing Address - Street 2:PMB 503
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3398
Mailing Address - Country:US
Mailing Address - Phone:619-297-1983
Mailing Address - Fax:619-297-6530
Practice Address - Street 1:1515 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2421
Practice Address - Country:US
Practice Address - Phone:619-297-1983
Practice Address - Fax:619-297-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100357332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5288800001Medicare ID - Type UnspecifiedPROVIDER NUMBER