Healthcare Provider Details

I. General information

NPI: 1083409213
Provider Name (Legal Business Name): FIRSTCARE MED SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 W HARVARD ST
GLENDALE CA
91204-1107
US

IV. Provider business mailing address

657 W HARVARD ST
GLENDALE CA
91204-1107
US

V. Phone/Fax

Practice location:
  • Phone: 818-208-5121
  • Fax: 818-208-5122
Mailing address:
  • Phone: 818-208-5121
  • Fax: 818-208-5122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAMVEL ASHOTI POLADYAN
Title or Position: PRESIDENT
Credential:
Phone: 818-538-1692