Healthcare Provider Details

I. General information

NPI: 1295976108
Provider Name (Legal Business Name): MEDIA MOGUL,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 W 127TH ST
LOS ANGELES CA
90044-1021
US

IV. Provider business mailing address

9029 AIRPORT BLVD 88844
LOS ANGELES CA
90009-4801
US

V. Phone/Fax

Practice location:
  • Phone: 323-375-9973
  • Fax:
Mailing address:
  • Phone: 323-375-9973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RAY DU BOC ALI
Title or Position: DIRECTOR / PRESIDENT
Credential: DIRECTOR
Phone: 323-375-9973