Healthcare Provider Details

I. General information

NPI: 1659517274
Provider Name (Legal Business Name): E Z LIVING MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 SUNFIELD AVE
LONG BEACH CA
90808-1332
US

IV. Provider business mailing address

4450 SUNFIELD AVE
LONG BEACH CA
90808-1332
US

V. Phone/Fax

Practice location:
  • Phone: 310-773-7615
  • Fax:
Mailing address:
  • Phone: 310-773-7615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN COOKE
Title or Position: AUTHORIZED DESIGNEE
Credential:
Phone: 310-773-7615