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General NPI Number Information
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NPI Number | 1285783712
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Entity Type | Organization
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Legal Business Name | MEDLIFE MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 9555 OWENSMOUTH AVE STE 9
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City | CHATSWORTH
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State | CA
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Zip | 91311-8000
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Country | US
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Telephone | 818-708-9444
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Fax | 888-981-8865
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Provider Business Mailing Address
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Address Line | 9555 OWENSMOUTH AVE STE 9
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City | CHATSWORTH
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State | CA
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Zip | 91311-8000
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Country | US
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Telephone | 818-708-9444
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VALENTINA POPERECHNAYA
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Credential |
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Telephone | 818-708-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 102667
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License Number State | CA
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