Healthcare Provider Details

I. General information

NPI: 1003624024
Provider Name (Legal Business Name): SOCAL MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12038 BURBANK BLVD
VALLEY VILLAGE CA
91607-1811
US

IV. Provider business mailing address

12038 BURBANK BLVD
VALLEY VILLAGE CA
91607-1811
US

V. Phone/Fax

Practice location:
  • Phone: 747-247-7724
  • Fax: 747-247-7712
Mailing address:
  • Phone: 747-247-7724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GEVORK ARABYAN
Title or Position: PRESIDENT
Credential:
Phone: 747-247-7724