Provider Demographics
NPI:1194956821
Name:TESLA SUPPLY COMPANY
Entity type:Organization
Organization Name:TESLA SUPPLY COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-927-1704
Mailing Address - Street 1:15923 BEAR VALLEY RD
Mailing Address - Street 2:D-270
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:82345
Mailing Address - Country:US
Mailing Address - Phone:760-948-7108
Mailing Address - Fax:866-238-3206
Practice Address - Street 1:15923 BEAR VALLEY RD
Practice Address - Street 2:D 270
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345
Practice Address - Country:US
Practice Address - Phone:866-238-3206
Practice Address - Fax:866-232-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies