Healthcare Provider Details

I. General information

NPI: 1447249818
Provider Name (Legal Business Name): STANLEY N. IGBOAKAEZE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15342 HAWTHORNE BLVD SUITE 206
LAWNDALE CA
90260-2192
US

IV. Provider business mailing address

15342 HAWTHORNE BLVD SUITE 206
LAWNDALE CA
90260-2192
US

V. Phone/Fax

Practice location:
  • Phone: 310-349-8346
  • Fax: 310-988-2194
Mailing address:
  • Phone: 310-349-8346
  • Fax: 310-988-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number103577
License Number StateCA

VIII. Authorized Official

Name: MR. STANLEY N IGBOAKAEZE
Title or Position: OWNER
Credential:
Phone: 310-349-8346