Healthcare Provider Details

I. General information

NPI: 1245353556
Provider Name (Legal Business Name): VERDUGO MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 ARTHUR ST SUITE A
LOS ANGELES CA
90065-2859
US

IV. Provider business mailing address

2614 ARTHUR ST SUITE A
LOS ANGELES CA
90065-2859
US

V. Phone/Fax

Practice location:
  • Phone: 818-408-1160
  • Fax:
Mailing address:
  • Phone: 818-408-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number000218940200011
License Number StateCA

VIII. Authorized Official

Name: MR. ARMEN SARGSYAN
Title or Position: PRESIDENT
Credential:
Phone: 818-408-1160