Provider Demographics
NPI:1417323916
Name:SOUTHLAND MEDICAL SUPPLY
Entity type:Organization
Organization Name:SOUTHLAND MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-699-6334
Mailing Address - Street 1:27511 COMMERCE CENTER DR
Mailing Address - Street 2:STE C
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2528
Mailing Address - Country:US
Mailing Address - Phone:951-699-6334
Mailing Address - Fax:
Practice Address - Street 1:27511 COMMERCE CENTER DR
Practice Address - Street 2:STE C
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2528
Practice Address - Country:US
Practice Address - Phone:951-699-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52671332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies