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Organization

AVETIS AVETISYAN

Active
Other names
A&T Medical Supply
Organization subpart
No

Provider details

NPI number
Authorized official
MR. AVETIS AVETISYAN (OWNER)
(650) 872-7002
Entity
Organization

Contact information

Practice address
1133 EL CAMINO REAL STE 7, SOUTH SAN FRANCISCO, CA 94080-3288
(650) 872-7002
(650) 872-0441
Mailing address
1133 EL CAMINO REAL, SUITE 7, SOUTH SAN FRANCISCO, CA 94080-3288
(650) 872-7002
(650) 872-0441

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
102525
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
620-18-6957
OWNERS SS #
CA
01
B6972866
OWNERS DRIVER LINCES #
CA
05
DME03047F
CA
Enumeration date
01/11/2007
Last updated
02/05/2009
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