Healthcare Provider Details

I. General information

NPI: 1114113347
Provider Name (Legal Business Name): GLOBAL MEDICAL NETWORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 W SUNSET BLVD STE 374
LOS ANGELES CA
90027-6302
US

IV. Provider business mailing address

4470 W SUNSET BLVD STE 374
LOS ANGELES CA
90027-6302
US

V. Phone/Fax

Practice location:
  • Phone: 213-613-1137
  • Fax: 213-617-8292
Mailing address:
  • Phone: 213-613-1137
  • Fax: 213-617-8292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number2806725
License Number StateCA

VIII. Authorized Official

Name: MS. ODARO OMOLARA OWEN
Title or Position: PRESIDENT/CEO
Credential: RN, MSN
Phone: 213-613-1137