Healthcare Provider Details

I. General information

NPI: 1720175243
Provider Name (Legal Business Name): NILE MEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 W MARTIN LUTHER KING JR BLVD
LOS ANGELES CA
90008-2727
US

IV. Provider business mailing address

2420 W MARTIN LUTHER KING JR BLVD
LOS ANGELES CA
90008-2727
US

V. Phone/Fax

Practice location:
  • Phone: 323-293-4204
  • Fax: 323-293-2851
Mailing address:
  • Phone: 323-293-4204
  • Fax: 323-293-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAULOS AYELE
Title or Position: OWNER
Credential:
Phone: 323-293-4204