Healthcare Provider Details

I. General information

NPI: 1184837957
Provider Name (Legal Business Name): OCB MEDICAL EQUIPMENT AND SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 S LA CIENEGA BLVD SUITE D
LOS ANGELES CA
90016-4400
US

IV. Provider business mailing address

3560 S LA CIENEGA BLVD SUITE D
LOS ANGELES CA
90016-4400
US

V. Phone/Fax

Practice location:
  • Phone: 323-954-8296
  • Fax: 323-954-8297
Mailing address:
  • Phone: 323-954-8296
  • Fax: 323-954-8297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number103408
License Number StateCA

VIII. Authorized Official

Name: CLEMENT AWAJI
Title or Position: PRESIDENT
Credential:
Phone: 323-954-8296