Organization
RIVERSIDE MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID W LEE (CEO)
(562) 254-7824
Entity
Organization
Contact information
Practice address
10280 INDIANA AVE, RIVERSIDE, CA 92503-5357
(951) 343-0428
Mailing address
10280 INDIANA AVE, RIVERSIDE, CA 92503-5357
(951) 343-0428
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7569370001
—
CA
Enumeration date
12/18/2018
Last updated
12/18/2018
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