MEDICARE: PERPETUAL HOME MEDICAL EQUIPMENT & SUPPLIES, 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

General Provider Information

NPI Number	:	1700089745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERPETUAL HOME MEDICAL EQUIPMENT & SUPPLIES, INC.

Provider Business Mailing Address
First Line	:	3018 BEVERLY BLVD
Second Line	:	UNIT C
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1027
Country	:	US
Telephone Number	:	213-388-9560
Fax Number	:	213-388-9561

Provider Business Practice Location Address
First Line	:	3018 BEVERLY BLVD
Second Line	:	UNIT C
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1027
Country	:	US
Telephone Number	:	213-388-9560
Fax Number	:	213-388-9561

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAIME CASTILLO SISON
Credential	:
Telephone Number	:	213-388-9560

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	03/10/2008

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