Promedica Medical Supply Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PROMEDICA MEDICAL SUPPLY INC

Practice address

1446 Front St Ste 200
San Diego, CA 92101-3425

Phone

(858) 800-3550

NPI assigned

Apr 1, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Viviann Carolina Valenzuela

Title

Ceo

Phone

(619) 621-8162

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706054400000",
    "number": "1316687627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1446 FRONT ST STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921013425",
            "telephone_number": "858-800-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1446 FRONT ST STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921013425",
            "telephone_number": "858-800-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA MEDICAL SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-01",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A",
        "authorized_official_last_name": "VALENZUELA",
        "authorized_official_first_name": "VIVIANN",
        "authorized_official_middle_name": "CAROLINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "619-621-8162"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in San Diego, CA
• Providers in San Diego, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2024; 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.