Healthcare Provider Details

I. General information

NPI: 1689434060
Provider Name (Legal Business Name): LA DME MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38733 9TH ST E STE Q
PALMDALE CA
93550-2910
US

IV. Provider business mailing address

4654 E AVENUE S # 173
PALMDALE CA
93552-4454
US

V. Phone/Fax

Practice location:
  • Phone: 661-495-5546
  • Fax:
Mailing address:
  • Phone: 661-825-7473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WARREN BATISTE
Title or Position: ADMINISTRATOR
Credential:
Phone: 661-495-5546