Healthcare Provider Details

I. General information

NPI: 1922914332
Provider Name (Legal Business Name): VITALPATH MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1159 EASTERN PKWY APT 2
BROOKLYN NY
11213-4191
US

IV. Provider business mailing address

1159 EASTERN PKWY APT 2
BROOKLYN NY
11213-4191
US

V. Phone/Fax

Practice location:
  • Phone: 713-776-6551
  • Fax: 713-776-6562
Mailing address:
  • Phone: 713-776-6551
  • Fax: 713-776-6562

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: MOHAMED OUEDRAGO
Title or Position: CEO
Credential:
Phone: 713-776-6551