Provider Demographics
NPI:1386914802
Name:MD MEDICAL SUPPLIES AND UNIFORMS
Entity type:Organization
Organization Name:MD MEDICAL SUPPLIES AND UNIFORMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DE AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-630-9002
Mailing Address - Street 1:321 SAN FELIPE RD.
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5247
Mailing Address - Country:US
Mailing Address - Phone:831-630-9002
Mailing Address - Fax:
Practice Address - Street 1:321 SAN FELIPE RD STE 9
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3035
Practice Address - Country:US
Practice Address - Phone:831-801-4172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1158
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-02
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1334332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies