# ULTRA MED SUPPLY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124829932
- **Authorized official:** ALEX JOHN (MANAGER)
- **Authorized official phone:** (408) 622-0120

## Contact information

- **Practice address:** 14030 KORNBLUM AVE APT 204, HAWTHORNE, CA 90250
- **Practice address phone:** (408) 622-0120
- **Mailing address:** 14030 KORNBLUM AVE APT 204, HAWTHORNE, CA 90250
- **Mailing address phone:** (408) 622-0120

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 03/19/2025
- **Last updated:** 03/19/2025