Healthcare Provider Details

I. General information

NPI: 1861474157
Provider Name (Legal Business Name): CYNNIES MEDICAL SUPPLY HOME EQUIPMENT CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 E SOUTH ST
LONG BEACH CA
90805-4633
US

IV. Provider business mailing address

PO BOX 17894
LONG BEACH CA
90807-7894
US

V. Phone/Fax

Practice location:
  • Phone: 562-984-0550
  • Fax: 562-984-0552
Mailing address:
  • Phone: 562-984-0550
  • Fax: 562-984-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number103544 & 17854
License Number StateCA

VIII. Authorized Official

Name: MRS. OSITA NGOZI AYENI
Title or Position: MANAGING DIRECTOR
Credential: N/A
Phone: 562-984-0550