Provider Demographics
NPI:1285801753
Name:911 MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:911 MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSEF-ISMEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-940-9009
Mailing Address - Street 1:305 E 4TH ST
Mailing Address - Street 2:SUITE. A2
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-2279
Mailing Address - Country:US
Mailing Address - Phone:951-940-9009
Mailing Address - Fax:951-940-9005
Practice Address - Street 1:305 E 4TH ST
Practice Address - Street 2:SUITE. A2
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2279
Practice Address - Country:US
Practice Address - Phone:951-940-9009
Practice Address - Fax:951-940-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6169640001Medicare NSC