Healthcare Provider Details

I. General information

NPI: 1235158106
Provider Name (Legal Business Name): ADVANTAGE MEDICAL SUPPLIES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S FAIRFAX AVE STE 306
LOS ANGELES CA
90036-3148
US

IV. Provider business mailing address

8205 SANTA MONICA BLVD # 1-464
WEST HOLLYWOOD CA
90046
US

V. Phone/Fax

Practice location:
  • Phone: 323-932-1055
  • Fax: 323-932-1017
Mailing address:
  • Phone: 323-932-1055
  • Fax: 323-932-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number102958
License Number StateCA

VIII. Authorized Official

Name: MR. YACOV STOLPNER
Title or Position: CFO
Credential:
Phone: 323-932-1055