Healthcare Provider Details

I. General information

NPI: 1225048705
Provider Name (Legal Business Name): OLOO MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15675 HAWTHORNE BLVD UNIT D
LAWNDALE CA
90260-2659
US

IV. Provider business mailing address

15675 HAWTHORNE BLVD UNIT D
LAWNDALE CA
90260-2659
US

V. Phone/Fax

Practice location:
  • Phone: 310-679-4106
  • Fax: 310-679-4164
Mailing address:
  • Phone: 310-679-4106
  • Fax: 310-679-4164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number06922
License Number StateCA

VIII. Authorized Official

Name: MR. EJIBE O. OKO
Title or Position: OWNER
Credential:
Phone: 310-679-4106