Organization
PROVIDENCE MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. YUSIF J SALIA (MANAGING DIRECTOR)
(213) 379-1424
Entity
Organization
Contact information
Practice address
1125 N MOUNTAIN AVE, ONTARIO, CA 91762-1739
(909) 443-7115
Mailing address
1125 N MOUNTAIN AVE, ONTARIO, CA 91762-1739
(909) 443-7115
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/04/2022
Last updated
12/25/2022
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