Pacific Medical Supply

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PACIFIC MEDICAL SUPPLY

Practice address

574 Calhoun St
Corona, CA 92879-5846

Phone

(951) 553-0322

Fax

(951) 279-6004

NPI assigned

Sep 27, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Fidelis Gabriel Ekong

Title

Owner

Phone

(951) 552-0322

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pacific Medical Supply Doing business as

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376634873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "574 CALHOUN ST",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928795846",
            "telephone_number": "951-553-0322",
            "fax_number": "951-279-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "574 CALHOUN ST",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928795846",
            "telephone_number": "951-553-0322",
            "fax_number": "951-279-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EKONG",
        "authorized_official_first_name": "FIDELIS",
        "authorized_official_middle_name": "GABRIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-552-0322",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "162054401/02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Medical Supply",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chricel Marie-Elmore Pace
• Carmela Pacheco
• Delia Ann Pacheco
• Pacific Dermatology Institute
• Pacific Kare LLC
• Amelia Grace Gines Padilla, RPH
• Andrea Padilla
• Ariana Padilla
• Marco A Paez, M.D.
• Phil Pafford

• Durable Medical Equipment & Medical Supplies in Corona, CA
• Providers in Corona, 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 Aug 22, 2020; 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.