MEDICARE: ADVANCE CARE 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

General Provider Information

NPI Number	:	1710466859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE CARE MEDICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	328 S ALVARADO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2915
Country	:	US
Telephone Number	:	213-385-5712
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 S ALVARADO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2915
Country	:	US
Telephone Number	:	213-385-5712
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PARVIN SULTANA
Credential	:
Telephone Number	:	213-385-5712

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	08/09/2018

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