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General NPI Number Information
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NPI Number | 1417041112
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Entity Type | Organization
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Legal Business Name | ANGELES VISTA MEDICAL SUPPLIES
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 11929 LOS NIETOS ROAD
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-2527
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Country | US
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Telephone | 562-699-7200
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Fax | 562-699-7210
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Provider Business Mailing Address
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Address Line | 11929 LOS NIETOS ROAD
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-2527
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Country | US
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Telephone | 562-699-7200
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Fax | 562-699-7210
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Authorized Official
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Title or Position | SOLE-PROPRIETOR
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Name | MR. MARKSON BOLA ALABI
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Credential | CO
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Telephone | 562-699-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | DME02177F
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | DME02177F
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | DME02177F
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License Number State | CA
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