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General NPI Number Information
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NPI Number | 1114014453
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Entity Type | Organization
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Legal Business Name | EMMANUEL MEDICAL SUPPLY & EQUIPMENT PROVIDER
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5107 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90037-3515
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Country | US
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Telephone | 323-971-6270
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Fax |
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Provider Business Mailing Address
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Address Line | 4415 ORCHARD AVE
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City | LOS ANGELES
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State | CA
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Zip | 90037-3017
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | LESLIE DUARTE
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Credential |
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Telephone | 323-327-8260
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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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