Healthcare Provider Details

I. General information

NPI: 1386837557
Provider Name (Legal Business Name): LIFELINE MED. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 S VICTORY BLVD
BURBANK CA
91502-2429
US

IV. Provider business mailing address

912 S VICTORY BLVD
BURBANK CA
91502-2429
US

V. Phone/Fax

Practice location:
  • Phone: 818-588-3281
  • Fax: 818-230-2252
Mailing address:
  • Phone: 818-588-3281
  • Fax: 818-230-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number000225251200019
License Number StateCA

VIII. Authorized Official

Name: RUBEN SHAHINIAN
Title or Position: PRESDENT
Credential:
Phone: 818-588-3281