Organization
CLUB DME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN PETERSON (PRESIDENT)
(877) 904-7030
Entity
Organization
Contact information
Practice address
3158 RED HILL AVE, SUITE 265, COSTA MESA, CA 92626-3416
(877) 904-7030
Mailing address
3158 RED HILL AVE, SUITE 265, COSTA MESA, CA 92626-3416
(877) 904-7030
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
05/15/2012
Last updated
05/15/2012
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