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General NPI Number Information
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NPI Number | 1356354807
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Entity Type | Organization
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Legal Business Name | PRESTIGE ENTERPRISE A MEDICAL SUPPLY CO.
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 1113 W GARDENA BLVD SUITE A
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City | GARDENA
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State | CA
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Zip | 90247-4887
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Country | US
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Telephone | 310-515-0979
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Fax | 310-515-1290
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Provider Business Mailing Address
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Address Line | 1113 W GARDENA BLVD SUITE A
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City | GARDENA
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State | CA
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Zip | 90247-4887
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Country | US
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Telephone | 310-515-0979
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GODFREY U. NWOGENE
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Credential |
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Telephone | 310-515-0979
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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 | 332B0000X
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License Number State | CA
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