Healthcare Provider Details

I. General information

NPI: 1992871180
Provider Name (Legal Business Name): SPEEDYCARE MEDICAL DISTRIBUTORS , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 S WESTERN AVE
LOS ANGELES CA
90047-3549
US

IV. Provider business mailing address

8955 S WESTERN AVE
LOS ANGELES CA
90047-3549
US

V. Phone/Fax

Practice location:
  • Phone: 323-242-2018
  • Fax: 323-834-0476
Mailing address:
  • Phone: 323-242-2018
  • Fax: 323-834-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number102327
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number102327
License Number StateCA

VIII. Authorized Official

Name: MR. JUDE I UWAEZUOKE
Title or Position: PRESIDENT
Credential:
Phone: 323-242-2018