Healthcare Provider Details

I. General information

NPI: 1942403068
Provider Name (Legal Business Name): DEBS MEDICAL DISTRIBUTORS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13615 VICTORY BLVD STE 136
VAN NUYS CA
91401-1737
US

IV. Provider business mailing address

13615 VICTORY BLVD STE 136
VAN NUYS CA
91401-1737
US

V. Phone/Fax

Practice location:
  • Phone: 818-376-1243
  • Fax:
Mailing address:
  • Phone: 818-376-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number47458
License Number StateCA

VIII. Authorized Official

Name: PATRICK SOGBEIN
Title or Position: OPERATION DIRECTOR
Credential:
Phone: 818-376-1243