# MAIN SOURCE MEDICAL SUPPLY

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

## Provider details

- **NPI number:** 1932485406
- **Authorized official:** JORGE LOMELI (OWNER)
- **Authorized official phone:** (714) 584-0127

## Contact information

- **Practice address:** 3624 RANDEE WAY, FULLERTON, CA 92833-2830
- **Practice address phone:** (714) 584-0127
- **Mailing address:** PO BOX 632, FULLERTON, CA 92836-0632
- **Mailing address phone:** (714) 584-0127

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 563007 | CA | Yes |

## Other

- **Enumeration date:** 10/28/2011
- **Last updated:** 10/28/2011