Healthcare Provider Details

I. General information

NPI: 1831362623
Provider Name (Legal Business Name): VAPOR MEDICAL DISTRIBUTORS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 MARINE AVE
GARDENA CA
90249-3726
US

IV. Provider business mailing address

2411 MARINE AVE
GARDENA CA
90249-3726
US

V. Phone/Fax

Practice location:
  • Phone: 310-538-1773
  • Fax:
Mailing address:
  • Phone: 310-538-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number49950
License Number StateCA

VIII. Authorized Official

Name: ADEKUNLE OGUNBANWO
Title or Position: OWNER/CEO
Credential:
Phone: 310-538-1773