Healthcare Provider Details

I. General information

NPI: 1336247360
Provider Name (Legal Business Name): COLFAX PHARMACEUTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11980 SAN VICENTE BLVD STE 104
LOS ANGELES CA
90049-5012
US

IV. Provider business mailing address

11980 SAN VICENTE BLVD STE 104
LOS ANGELES CA
90049-5012
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-1496
  • Fax: 310-820-4186
Mailing address:
  • Phone: 310-820-1496
  • Fax: 310-820-4186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number51494
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BEN TEHRANI
Title or Position: CEO/PIC
Credential: PHARM. D
Phone: 310-820-1496