Organization
MEDICAL SUPPLIES IHP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID QUIROZ MBA (OWNER)
(805) 517-2995
Entity
Organization
Contact information
Practice address
530 NEW LOS ANGELES AVE, STE 117, MOORPARK, CA 93021-2081
(805) 517-2995
(805) 517-1237
Mailing address
530 NEW LOS ANGELES AVE, STE 117, MOORPARK, CA 93021-2081
(805) 517-2995
(805) 517-1237
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
57836
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23019
HMDR EXEMPTEE LICENSE
CA
01
—
57836
HMDRL
CA
Enumeration date
08/26/2013
Last updated
08/26/2013
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