Provider Demographics
NPI:1508246133
Name:REVOLUTION MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:REVOLUTION MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-471-1122
Mailing Address - Street 1:571 CRANE ST
Mailing Address - Street 2:UNIT H
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2742
Mailing Address - Country:US
Mailing Address - Phone:951-471-1122
Mailing Address - Fax:951-471-1123
Practice Address - Street 1:571 CRANE ST
Practice Address - Street 2:UNIT H
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2742
Practice Address - Country:US
Practice Address - Phone:951-471-1122
Practice Address - Fax:951-471-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies