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General NPI Number Information
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NPI Number | 1083641617
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Entity Type | Organization
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Legal Business Name | ACE MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15030 PRAIRIE AVENUE
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City | LOS ANGELES
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State | CA
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Zip | 90250
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Country | US
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Telephone | 310-676-2060
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Fax | 310-676-3612
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Provider Business Mailing Address
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Address Line | 15030 PRAIRIE AVENUE
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City | LOS ANGELES
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State | CA
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Zip | 90250
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Country | US
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Telephone | 310-676-2060
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Fax | 310-676-3612
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Authorized Official
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Title or Position | OWNER
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Name | ABIJATU H SESAY
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Credential |
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Telephone | 310-676-2060
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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 | 5672260001
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License Number State | CA
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