MEDICARE: SOUTHLAND MEDICAL CARE,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	332BX2000X	Oxygen Equipment & Supplies (DME)	103221	CA

General Provider Information

NPI Number	:	1528075439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHLAND MEDICAL CARE,INC.

Provider Business Mailing Address
First Line	:	3550 WILSHIRE BLVD
Second Line	:	SUITE 1138
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2401
Country	:	US
Telephone Number	:	213-738-0020
Fax Number	:	213-738-0024

Provider Business Practice Location Address
First Line	:	3550 WILSHIRE BLVD
Second Line	:	SUITE 1138
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2401
Country	:	US
Telephone Number	:	213-738-0020
Fax Number	:	213-738-0024

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SYLVESTER ASHIEDU OKOCHA
Credential	:	RESPIROTORY THERAPIS
Telephone Number	:	213-738-0020

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	10/31/2007

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