Provider Demographics
NPI:1366755795
Name:LYNWOOD MED SUPPLY, INC.
Entity type:Organization
Organization Name:LYNWOOD MED SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLORIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-973-2060
Mailing Address - Street 1:10136 LONG BEACH BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-1560
Mailing Address - Country:US
Mailing Address - Phone:323-973-2060
Mailing Address - Fax:323-973-2065
Practice Address - Street 1:10136 LONG BEACH BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-1560
Practice Address - Country:US
Practice Address - Phone:323-973-2060
Practice Address - Fax:323-973-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies