Healthcare Provider Details

I. General information

NPI: 1528075439
Provider Name (Legal Business Name): SOUTHLAND MEDICAL CARE,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 WILSHIRE BLVD SUITE 1138
LOS ANGELES CA
90010-2401
US

IV. Provider business mailing address

3550 WILSHIRE BLVD SUITE 1138
LOS ANGELES CA
90010-2401
US

V. Phone/Fax

Practice location:
  • Phone: 213-738-0020
  • Fax: 213-738-0024
Mailing address:
  • Phone: 213-738-0020
  • Fax: 213-738-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number103221
License Number StateCA

VIII. Authorized Official

Name: MR. SYLVESTER ASHIEDU OKOCHA
Title or Position: PRESIDENT
Credential: RESPIROTORY THERAPIS
Phone: 213-738-0020