Provider Demographics
NPI:1730555954
Name:SOUTH BAY MEDIQUIPMENT INC
Entity type:Organization
Organization Name:SOUTH BAY MEDIQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-994-6942
Mailing Address - Street 1:1206 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-3203
Mailing Address - Country:US
Mailing Address - Phone:619-794-2099
Mailing Address - Fax:619-362-9616
Practice Address - Street 1:1206 THIRD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3203
Practice Address - Country:US
Practice Address - Phone:619-794-2099
Practice Address - Fax:619-362-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77206OtherHOME MEDICAL DEVICE RETAIL LICENSE