Providence Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PROVIDENCE MEDICAL SUPPLY LLC

Practice address

1125 N Mountain Ave
Ontario, CA 91762-1739

Phone

(909) 443-7115

NPI assigned

Oct 4, 2022

Last updated

Dec 25, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Yusif J Salia

Title

Managing Director

Phone

(213) 379-1424

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1664841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671926400000",
    "number": "1659096410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 N MOUNTAIN AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917621739",
            "telephone_number": "909-443-7115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 N MOUNTAIN AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917621739",
            "telephone_number": "909-443-7115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-04",
        "last_updated": "2022-12-25",
        "certification_date": "2022-12-25",
        "status": "A",
        "authorized_official_last_name": "SALIA",
        "authorized_official_first_name": "YUSIF",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "213-379-1424",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Ontario, CA
• Providers in Ontario, 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 Dec 25, 2022; 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.