# MIRACLE MEDICAL

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

## Provider details

- **NPI number:** 1679894620
- **Authorized official:** RANDY ABABSEH (SOLE MEMBER)
- **Authorized official phone:** (805) 432-0072

## Contact information

- **Practice address:** 2025 SUEDE ST, SIMI VALLEY, CA 93063-4012
- **Practice address phone:** (805) 432-0072
- **Mailing address:** 2025 SUEDE ST, SIMI VALLEY, CA 93063-4012

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 06/14/2010
- **Last updated:** 06/14/2010