Provider Demographics
NPI:1023113180
Name:SMART MEDICAL SUPPLIES
Entity type:Organization
Organization Name:SMART MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JULIETA
Authorized Official - Middle Name:ESTEBAN
Authorized Official - Last Name:ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, DON
Authorized Official - Phone:818-772-4979
Mailing Address - Street 1:18701 PARTHENIA ST STE 3
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3814
Mailing Address - Country:US
Mailing Address - Phone:818-772-4979
Mailing Address - Fax:
Practice Address - Street 1:18701 PARTHENIA ST STE 3
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3814
Practice Address - Country:US
Practice Address - Phone:818-772-4979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02570FMedicaid
CADME02570FMedicaid