Healthcare Provider Details

I. General information

NPI: 1831302850
Provider Name (Legal Business Name): COLGATE MEDICAL AND SURGICAL SUPPLIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S FAIRFAX AVE STE 209
LOS ANGELES CA
90036-3148
US

IV. Provider business mailing address

425 S FAIRFAX AVE STE 209
LOS ANGELES CA
90036-3148
US

V. Phone/Fax

Practice location:
  • Phone: 323-782-0145
  • Fax: 323-782-0273
Mailing address:
  • Phone: 323-782-0145
  • Fax: 323-782-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number52093
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number52093
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number52093
License Number StateCA

VIII. Authorized Official

Name: MRS. LANA KAGANOVSKY
Title or Position: PRESIDENT
Credential:
Phone: 323-782-0145