MEDICARE: STANLEY N. IGBOAKAEZE

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	103577	CA

General Provider Information

NPI Number	:	1447249818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANLEY N. IGBOAKAEZE

Provider Business Mailing Address
First Line	:	15342 HAWTHORNE BLVD
Second Line	:	SUITE 206
City	:	LAWNDALE
State	:	CA
Zip	:	90260-2192
Country	:	US
Telephone Number	:	310-349-8346
Fax Number	:	310-988-2194

Provider Business Practice Location Address
First Line	:	15342 HAWTHORNE BLVD
Second Line	:	SUITE 206
City	:	LAWNDALE
State	:	CA
Zip	:	90260-2192
Country	:	US
Telephone Number	:	310-349-8346
Fax Number	:	310-988-2194

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STANLEY N IGBOAKAEZE
Credential	:
Telephone Number	:	310-349-8346

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	02/20/2008

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