MEDICARE: IDA MED MEDICAL EQUIPMENT

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	100642	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4204220001	OTHER	CA	MEDICARE ID PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245224427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDA MED MEDICAL EQUIPMENT

Provider Business Mailing Address
First Line	:	12792 VALLEY VIEW ST
Second Line	:	STE C
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845
Country	:	US
Telephone Number	:	714-894-1818
Fax Number	:	714-894-3121

Provider Business Practice Location Address
First Line	:	12792 VALLEY VIEW ST
Second Line	:	STE C
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2509
Country	:	US
Telephone Number	:	714-894-1818
Fax Number	:	714-894-3121

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	MEHDI ABHARI
Credential	:
Telephone Number	:	714-894-1818

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	06/27/2008

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Directions to “IDA MED MEDICAL EQUIPMENT ” Practice Location

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