MEDICARE: LIPO 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
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1487854386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIPO MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	13711 BURBANK BLVD
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-5040
Country	:	US
Telephone Number	:	818-994-4948
Fax Number	:	818-994-4533

Provider Business Practice Location Address
First Line	:	13711 BURBANK BLVD
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-5040
Country	:	US
Telephone Number	:	818-994-4948
Fax Number	:	818-994-4533

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LIPARIT CHARCHYAN
Credential	:
Telephone Number	:	818-994-4948

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	11/20/2007

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