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General NPI Number Information
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NPI Number | 1295976108
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Entity Type | Organization
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Legal Business Name | MEDIA MOGUL,INC
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 1223 W 127TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90044-1021
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Country | US
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Telephone | 323-375-9973
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Fax |
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Provider Business Mailing Address
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Address Line | 9029 AIRPORT BLVD 88844
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City | LOS ANGELES
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State | CA
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Zip | 90009-4801
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Country | US
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Telephone | 323-375-9973
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Fax |
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Authorized Official
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Title or Position | DIRECTOR / PRESIDENT
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Name | MR. RAY DU BOC ALI
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Credential | DIRECTOR
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Telephone | 323-375-9973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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