Healthcare Provider Details

I. General information

NPI: 1538376298
Provider Name (Legal Business Name): LAX HEALTH CARE TECHNOLGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8939 S SEPULVEDA BLVD SUITE 424
LOS ANGELES CA
90045-3631
US

IV. Provider business mailing address

8939 S SEPULVEDA BLVD SUITE 424
LOS ANGELES CA
90045-3631
US

V. Phone/Fax

Practice location:
  • Phone: 310-410-9907
  • Fax: 310-410-9387
Mailing address:
  • Phone: 310-410-9907
  • Fax: 310-410-9387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number46844
License Number StateCA

VIII. Authorized Official

Name: CHRIS NGOZI OGWONUWE
Title or Position: OWNER
Credential:
Phone: 310-738-0387