Healthcare Provider Details

I. General information

NPI: 1619084720
Provider Name (Legal Business Name): LORD'S MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 W 139TH ST SUITE E
GARDENA CA
90249-2642
US

IV. Provider business mailing address

1552 W 139TH STREET SUITE E
GARDENA CA
90249-2642
US

V. Phone/Fax

Practice location:
  • Phone: 310-324-0516
  • Fax: 310-324-0518
Mailing address:
  • Phone: 310-324-0516
  • Fax: 310-324-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number103477
License Number StateCA

VIII. Authorized Official

Name: O. TEMITOPE ANIFOWOSE
Title or Position: OWNER
Credential:
Phone: 310-324-0516