Organization Active NPI

Medtech Medical Supply, LLC

  • Durable Medical Equipment & Medical Supplies
  • West Covina, CA
National Provider Identifier
1033325667
Registry record updated May 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
49380 Issued in CA
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

Updated by the provider on May 6, 2009

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)CodeLicenseStatePrimary
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 Directory

Locations

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.

Verify at the official NPI Registry.