Provider Demographics
NPI:1154755148
Name:MEDICAL SUPPLIES IHP
Entity type:Organization
Organization Name:MEDICAL SUPPLIES IHP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIROZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:805-517-2995
Mailing Address - Street 1:530 NEW LOS ANGELES AVE
Mailing Address - Street 2:STE 117
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2081
Mailing Address - Country:US
Mailing Address - Phone:805-517-2995
Mailing Address - Fax:805-517-1237
Practice Address - Street 1:530 NEW LOS ANGELES AVE
Practice Address - Street 2:STE 117
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2081
Practice Address - Country:US
Practice Address - Phone:805-517-2995
Practice Address - Fax:805-517-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57836332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23019OtherHMDR EXEMPTEE LICENSE
CA57836OtherHMDRL