MEDICARE: PROHEALTH 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	54295	CA

General Provider Information

NPI Number	:	1104123652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROHEALTH MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	4509 EAGLE ROCK BLVD
Second Line	:	STE B
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-3214
Country	:	US
Telephone Number	:	323-255-3504
Fax Number	:	323-255-3504

Provider Business Practice Location Address
First Line	:	4509 EAGLE ROCK BLVD
Second Line	:	STE B
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-3214
Country	:	US
Telephone Number	:	323-255-3504
Fax Number	:	323-255-3504

Authorized Official
Title or Position	:	CEO/MANAGER
Name	:	MRS. ARSINEH ALMASI
Credential	:
Telephone Number	:	323-255-3504

Provider Enumeration Date	:	02/18/2011
Last Update Date	:	02/25/2011

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