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General NPI Number Information
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NPI Number | 1073752820
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Entity Type | Organization
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Legal Business Name | MEDICALSTATIONSUPPLY
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 1143 S LOS ANGELES ST
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City | LOS ANGELES
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State | CA
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Zip | 90015-2536
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Country | US
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Telephone | 310-770-7309
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Fax | 213-612-4936
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Provider Business Mailing Address
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Address Line | 120 N ELM DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-5510
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Country | US
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Telephone | 310-279-0624
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Fax | 213-612-4936
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Authorized Official
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Title or Position | TREASURER
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Name | DANIEL AZIZI
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Credential |
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Telephone | 310-279-0642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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