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General NPI Number Information
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NPI Number | 1194998765
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Entity Type | Organization
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Legal Business Name | HERITAGE MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 04/03/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 1210 S LA BREA AVE STE I
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City | INGLEWOOD
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State | CA
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Zip | 90301-3891
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Country | US
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Telephone | 310-256-4870
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Fax | 310-673-1971
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Provider Business Mailing Address
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Address Line | 1210 S LA BREA AVE STE I
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City | INGLEWOOD
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State | CA
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Zip | 90301-3891
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Country | US
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Telephone | 310-256-4870
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Fax | 310-673-1971
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Authorized Official
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Title or Position | CEO
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Name | MR. ABERA GEBRE
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Credential |
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Telephone | 310-678-5886
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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 | 48597
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License Number State | CA
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