Organization
MIRA INTEGRATED HOLDINGS INC
Active
Other names
Supreme Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ARNOLD AQUINO (PRESIDENT)
(909) 657-5557
Entity
Organization
Contact information
Practice address
433 W ALLEN AVE STE 112, SAN DIMAS, CA 91773-4704
(909) 657-5557
(909) 657-9990
Mailing address
433 W ALLEN AVE STE 112, SAN DIMAS, CA 91773-4704
(909) 657-5557
(909) 657-9990
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
98254
CA
Other
Enumeration date
02/27/2018
Last updated
01/21/2022
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