Healthcare Provider Details

I. General information

NPI: 1629240890
Provider Name (Legal Business Name): PROGRESSIVE MEDICAL INDUSTRIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E FLORENCE AVE
INGLEWOOD CA
90301-1202
US

IV. Provider business mailing address

310 E FLORENCE AVE
INGLEWOOD CA
90301-1202
US

V. Phone/Fax

Practice location:
  • Phone: 310-674-7528
  • Fax: 310-674-7224
Mailing address:
  • Phone: 310-674-7528
  • Fax: 310-674-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1184460001
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number1629240890
License Number StateCA

VIII. Authorized Official

Name: DR. LENORE T COLEMAN
Title or Position: COORDINATOR
Credential: PHARM,D-CDE
Phone: 703-795-1983