Provider Demographics
NPI:1336208362
Name:SUNMED MEDICAL SYSTEMS LLC
Entity Type:Organization
Organization Name:SUNMED MEDICAL SYSTEMS LLC
Other - Org Name:MJ MEDICAL INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LOBOSCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-552-6905
Mailing Address - Street 1:8893 LA MESA BLVD.
Mailing Address - Street 2:SUITE E
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-5465
Mailing Address - Country:US
Mailing Address - Phone:619-644-2695
Mailing Address - Fax:619-644-2698
Practice Address - Street 1:8893 LA MESA BLVD.
Practice Address - Street 2:SUITE E
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-5465
Practice Address - Country:US
Practice Address - Phone:619-644-2695
Practice Address - Fax:619-644-2698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA011064332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5568050001Medicare ID - Type Unspecified