Healthcare Provider Details

I. General information

NPI: 1487533261
Provider Name (Legal Business Name): WVG MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 COLORADO BLVD STE 6
LOS ANGELES CA
90041-1170
US

IV. Provider business mailing address

2455 COLORADO BLVD STE 6
LOS ANGELES CA
90041-1170
US

V. Phone/Fax

Practice location:
  • Phone: 213-602-7123
  • Fax:
Mailing address:
  • Phone: 213-602-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. SHEMIAIH ERIN JIZ
Title or Position: PRESIDENT
Credential:
Phone: 213-602-7123