Healthcare Provider Details

I. General information

NPI: 1841616018
Provider Name (Legal Business Name): MARTIN LUTHER VOCATIONAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 S ROSEMEAD BLVD
PASADENA CA
91107
US

IV. Provider business mailing address

428 S ROSEMEAD BLVD
PASADENA CA
91107
US

V. Phone/Fax

Practice location:
  • Phone: 626-639-3875
  • Fax: 626-639-3975
Mailing address:
  • Phone: 626-639-3975
  • Fax: 626-639-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. PAULINUS NDIBE
Title or Position: CEO
Credential:
Phone: 626-639-3975