Provider Demographics
NPI:1669847745
Name:RAM DURABLE MEDICAL EQUIPMENT, LLC
Entity type:Organization
Organization Name:RAM DURABLE MEDICAL EQUIPMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-549-1771
Mailing Address - Street 1:7909 SILVERTON AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6347
Mailing Address - Country:US
Mailing Address - Phone:858-549-1771
Mailing Address - Fax:858-549-1777
Practice Address - Street 1:4235 PACIFIC ST
Practice Address - Street 2:UNIT C
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2141
Practice Address - Country:US
Practice Address - Phone:760-402-8096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77444332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9222139Medicaid
6310290001Medicare NSC