Active NPI
Medtech Medical Supply, LLC
- Durable Medical Equipment & Medical Supplies
- West Covina, CA
National Provider Identifier
1033325667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 49380
- Legal business name
- MEDTECH MEDICAL SUPPLY, LLC
- Practice address
- 1331 W Garvey Ave N
West Covina, CA 91790-2242 - Phone
- (626) 962-7580
- Fax
- (626) 960-1659
- NPI assigned
- May 14, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Olawale Ayoola Oyetibo
- Title
- Member
- Phone
- (626) 962-7580
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 49380 | CA | Primary |
Addresses
Primary practice location
1331 W Garvey Ave N
West Covina, CA 91790-2242
Mailing address
PO Box 2098
Pomona, CA 91769-2098
Phone (626) 962-7580
National Provider Directory
National Provider DirectoryLocations
1331 W Garvey Ave N
West Covina, CA 91790
Phone (626) 962-7580
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179100800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1241568000000",
"number": "1033325667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2098",
"city": "POMONA",
"state": "CA",
"postal_code": "917692098",
"telephone_number": "626-962-7580",
"fax_number": "626-960-1659"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1331 W GARVEY AVE N",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917902242",
"telephone_number": "626-962-7580",
"fax_number": "626-960-1659"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDTECH MEDICAL SUPPLY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-14",
"last_updated": "2009-05-06",
"status": "A",
"authorized_official_last_name": "OYETIBO",
"authorized_official_first_name": "OLAWALE",
"authorized_official_middle_name": "AYOOLA",
"authorized_official_title_or_position": "MEMBER",
"authorized_official_telephone_number": "626-962-7580"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "CA",
"license": "49380",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in West Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.