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General NPI Number Information
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NPI Number | 1124257118
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Entity Type | Organization
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Legal Business Name | AG MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 4020 W MAGNOLIA BLVD STE C
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City | BURBANK
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State | CA
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Zip | 91505-2828
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Country | US
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Telephone | 818-846-1111
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Fax | 818-276-8371
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Provider Business Mailing Address
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Address Line | 4020 W MAGNOLIA BLVD STE C
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City | BURBANK
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State | CA
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Zip | 91505-2828
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Country | US
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Telephone | 818-846-1111
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Fax | 818-276-8371
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Authorized Official
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Title or Position | PRESIDENT
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Name | GAIANE AROUSH
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Credential |
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Telephone | 818-846-1411
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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 | 101-252329
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License Number State | CA
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