MEDICARE: ANGELS 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	20161887	AZ

General Provider Information

NPI Number	:	1861512303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	9291 FERMI AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-3148
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 E MCDOWELL RD STE 408
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4448
Country	:	US
Telephone Number	:	602-286-0311
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS GRISEL RAMIREZ
Credential	:
Telephone Number	:	602-286-0311

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/20/2007

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