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General NPI Number Information
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NPI Number | 1508531377
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Entity Type | Organization
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Legal Business Name | INTERSTATE MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 1096 N WESTERN AVE STE 202
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City | LOS ANGELES
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State | CA
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Zip | 90029-2340
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Country | US
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Telephone | 949-386-4054
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Fax | 800-886-7086
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Provider Business Mailing Address
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Address Line | PO BOX 3342
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City | GLENDALE
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State | CA
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Zip | 91221-0342
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Country | US
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Telephone | 949-386-4054
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Fax | 800-886-7086
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Authorized Official
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Title or Position | CEO
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Name | MR. HAIG CHRISTOPHER AVAKIAN
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Credential | COF
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Telephone | 949-386-4054
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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 |
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License Number State |
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