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General NPI Number Information
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NPI Number | 1619084720
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Entity Type | Organization
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Legal Business Name | LORD'S MEDICAL SUPPLY
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1552 W 139TH ST SUITE E
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City | GARDENA
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State | CA
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Zip | 90249-2642
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Country | US
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Telephone | 310-324-0516
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Fax | 310-324-0518
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Provider Business Mailing Address
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Address Line | 1552 W 139TH STREET SUITE E
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City | GARDENA
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State | CA
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Zip | 90249-2642
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Country | US
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Telephone | 310-324-0516
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Fax | 310-324-0518
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Authorized Official
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Title or Position | OWNER
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Name | O. TEMITOPE ANIFOWOSE
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Credential |
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Telephone | 310-324-0516
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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 | 103477
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License Number State | CA
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