Provider Demographics
NPI:1861578247
Name:TRIPPLE R NEW LIFE MEDICAL SUPPLIES
Entity type:Organization
Organization Name:TRIPPLE R NEW LIFE MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V. P.
Authorized Official - Prefix:MS
Authorized Official - First Name:BLESSING
Authorized Official - Middle Name:C
Authorized Official - Last Name:OKWARA
Authorized Official - Suffix:
Authorized Official - Credentials:R N
Authorized Official - Phone:909-623-8136
Mailing Address - Street 1:1641 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2911
Mailing Address - Country:US
Mailing Address - Phone:909-623-8136
Mailing Address - Fax:909-623-8182
Practice Address - Street 1:1641 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2911
Practice Address - Country:US
Practice Address - Phone:909-623-8136
Practice Address - Fax:909-623-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44551332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44551OtherHMDR
CA=========OtherEIN
CA44551OtherHMDR