Organization
INLAND SURGICAL SUPPLY CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD M LIRA (MANAGER)
(909) 946-4449
Entity
Organization
Contact information
Practice address
436 N CENTRAL AVE, UPLAND, CA 91786-4218
(909) 946-4449
(909) 946-5951
Mailing address
436 N CENTRAL AVE, UPLAND, CA 91786-4218
(909) 946-4449
(909) 946-5951
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
SR EH 100-360603
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ70830Z
—
CA
Enumeration date
08/30/2007
Last updated
08/30/2007
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