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General NPI Number Information
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NPI Number | 1588860720
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Entity Type | Organization
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Legal Business Name | DW MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 1524 CENTINELA AVE
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City | INGLEWOOD
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State | CA
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Zip | 90302-1144
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Country | US
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Telephone | 310-330-0162
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Fax | 323-292-0227
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Provider Business Mailing Address
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Address Line | 1524 CENTINELA AVE
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City | INGLEWOOD
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State | CA
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Zip | 90302-1144
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Country | US
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Telephone | 310-330-0162
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Fax | 323-292-0227
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEREGE K. WORKU
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Credential |
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Telephone | 310-330-0162
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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 | 47555
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License Number State | CA
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