# JACK QUEREQUINCIA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Simi Medical Equipment
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376544114
- **Authorized official:** JACK DANIEL QUEREQUINCIA (OWNER)
- **Authorized official phone:** (805) 581-5905

## Contact information

- **Practice address:** 2375 SYCAMORE DR, SUITE 4, SIMI VALLEY, CA 93065-2787
- **Practice address phone:** (805) 581-5905
- **Practice address fax:** (805) 581-1478
- **Mailing address:** 2375 SYCAMORE DR, SUITE 4, SIMI VALLEY, CA 93065-2787
- **Mailing address phone:** (805) 581-5905
- **Mailing address fax:** (805) 581-1478

## Taxonomy

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

## Other

- **Enumeration date:** 08/02/2005
- **Last updated:** 08/22/2020