# MIRA INTEGRATED HOLDINGS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Supreme Healthcare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902307713
- **Authorized official:** MR. ARNOLD AQUINO (PRESIDENT)
- **Authorized official phone:** (909) 657-5557

## Contact information

- **Practice address:** 433 W ALLEN AVE STE 112, SAN DIMAS, CA 91773-4704
- **Practice address phone:** (909) 657-5557
- **Practice address fax:** (909) 657-9990
- **Mailing address:** 433 W ALLEN AVE STE 112, SAN DIMAS, CA 91773-4704
- **Mailing address phone:** (909) 657-5557
- **Mailing address fax:** (909) 657-9990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 98254 | CA | Yes |

## Other

- **Enumeration date:** 02/27/2018
- **Last updated:** 01/21/2022