Organization
MAIN SOURCE MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE LOMELI (OWNER)
(714) 584-0127
Entity
Organization
Contact information
Practice address
3624 RANDEE WAY, FULLERTON, CA 92833-2830
(714) 584-0127
Mailing address
PO BOX 632, FULLERTON, CA 92836-0632
(714) 584-0127
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
563007
CA
Other
Enumeration date
10/28/2011
Last updated
10/28/2011
Update your record
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