MEDICARE: VILA MEDICAL SUPPLY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		CA

General Provider Information

NPI Number	:	1063425668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILA MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	PO BOX 56334
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91413-1334
Country	:	US
Telephone Number	:	818-785-7722
Fax Number	:	818-785-7772

Provider Business Practice Location Address
First Line	:	14545 FRIAR ST
Second Line	:	SUITE 112
City	:	VAN NUYS
State	:	CA
Zip	:	91411-2357
Country	:	US
Telephone Number	:	818-785-7722
Fax Number	:	818-785-7772

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	IVAN TOKAREV
Credential	:
Telephone Number	:	818-437-9434

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/22/2020

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