=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043640402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELIABLE MEDICAL SUPPLY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2013
-----------------------------------------------------
Last Update Date | 11/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 454 S ROBERTSON BLVD # D-1
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-3972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-651-9822
-----------------------------------------------------
Fax | 310-786-2063
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8306 WILSHIRE BLVD # 2028
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90211-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-651-9822
-----------------------------------------------------
Fax | 310-786-2063
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | ALEXANDER POBEREJSKY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-651-9822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 56659
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------