Provider Demographics
NPI:1235272188
Name:A1 QUALITY MEDICAL SUPPLY
Entity type:Organization
Organization Name:A1 QUALITY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEWALE
Authorized Official - Middle Name:O
Authorized Official - Last Name:FAJEWONYOMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-433-0111
Mailing Address - Street 1:582 W VALLEY BLVD
Mailing Address - Street 2:UNIT 9
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2273
Mailing Address - Country:US
Mailing Address - Phone:909-433-0111
Mailing Address - Fax:909-433-0231
Practice Address - Street 1:582 W VALLEY BLVD
Practice Address - Street 2:UNIT 9
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-2273
Practice Address - Country:US
Practice Address - Phone:909-433-0111
Practice Address - Fax:909-433-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5899970001Medicare NSC