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General NPI Number Information
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NPI Number | 1295847598
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Entity Type | Organization
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Legal Business Name | VICTORY CARE MEDICAL SUPPLY INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/08/2010
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Provider Practice Location Address
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Address Line | 6342 COLDWATER CANYON AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-2911
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Country | US
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Telephone | 818-763-4814
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Fax | 818-763-1362
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Provider Business Mailing Address
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Address Line | 6342 COLWATER CANYON AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-2911
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Country | US
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Telephone | 818-763-4814
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Fax | 818-763-1362
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Authorized Official
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Title or Position | PRESIDENT
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Name | AKAKI KARITCHASHVILI
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Credential |
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Telephone | 818-763-4841
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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 | 0000779083-0001-0
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License Number State | CA
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