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General NPI Number Information
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NPI Number | 1558472886
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Entity Type | Organization
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Legal Business Name | ALPHA OMEGA MEDICAL SUPPLY,INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 1626 CENTINELA AVE SUITE 1
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City | INGLEWOOD
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State | CA
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Zip | 90302-1047
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Country | US
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Telephone | 310-670-5890
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Fax | 310-670-3588
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Provider Business Mailing Address
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Address Line | 1626 CENTINELA AVE SUITE 1
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City | INGLEWOOD
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State | CA
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Zip | 90302-1047
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Country | US
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Telephone | 310-670-5890
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Fax | 310-670-3588
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. EDEN G GEBERSELASSIE
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Credential |
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Telephone | 310-670-5890
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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 | 102992
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License Number State | CA
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