Provider Demographics
NPI:1720887581
Name:PROMAX MEDICAL SUPPLIES INC.
Entity type:Organization
Organization Name:PROMAX MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:VILLANAS
Authorized Official - Last Name:ROSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-930-3366
Mailing Address - Street 1:9208 BLOOMFIELD AVE APT 70
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2447
Mailing Address - Country:US
Mailing Address - Phone:714-350-7324
Mailing Address - Fax:
Practice Address - Street 1:6816 E KATELLA RD
Practice Address - Street 2:UNIT 1073
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630
Practice Address - Country:US
Practice Address - Phone:714-350-7324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies