Provider Demographics
NPI:1952000416
Name:TOTAL HEALTH SUPPLY LLC
Entity Type:Organization
Organization Name:TOTAL HEALTH SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDARUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-495-3625
Mailing Address - Street 1:2729 BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7930
Mailing Address - Country:US
Mailing Address - Phone:657-495-3625
Mailing Address - Fax:
Practice Address - Street 1:2729 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7930
Practice Address - Country:US
Practice Address - Phone:657-495-3625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies