Organization
CHAMPION MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEROME KEVIN TYLER (OWNER)
(310) 462-1944
Entity
Organization
Contact information
Practice address
1996 GLENTANA ST, SIMI VALLEY, CA 93065-0553
(310) 462-1944
(805) 582-9873
Mailing address
1996 GLENTANA STREET, SIMI VALLEY, CA 93065
(310) 462-1944
(805) 582-9873
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
01/28/2008
Last updated
01/28/2008
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