Healthcare Provider Details

I. General information

NPI: 1053165191
Provider Name (Legal Business Name): VERINA CO MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E BROADWAY STE 203
GLENDALE CA
91205-4066
US

IV. Provider business mailing address

1224 E BROADWAY STE 203
GLENDALE CA
91205-4066
US

V. Phone/Fax

Practice location:
  • Phone: 818-479-1585
  • Fax: 818-864-6509
Mailing address:
  • Phone: 818-479-1585
  • Fax: 818-864-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RAMY WAHBA
Title or Position: OWNER
Credential:
Phone: 818-479-1585