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General NPI Number Information
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NPI Number | 1407945504
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Entity Type | Organization
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Legal Business Name | GERTRUDE IHENACHOR
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 09/04/2009
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Provider Practice Location Address
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Address Line | 825 W GARDENA BLVD
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City | GARDENA
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State | CA
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Zip | 90247-3030
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Country | US
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Telephone | 310-327-6977
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Fax | 310-327-6980
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Provider Business Mailing Address
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Address Line | 14612 S CATALINA AVE
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City | GARDENA
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State | CA
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Zip | 90247-3030
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Country | US
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Telephone | 310-327-6977
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Fax | 310-327-6980
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Authorized Official
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Title or Position | OWNER
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Name | GERTRUDE ULOMA IHENACHOR
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Credential |
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Telephone | 310-327-6977
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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 | 51946
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License Number State | CA
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