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General NPI Number Information
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NPI Number | 1710960885
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Entity Type | Organization
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Legal Business Name | EQUICARE MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 1154 S ALVARADO ST
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City | LOS ANGELES
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State | CA
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Zip | 90006-4110
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Country | US
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Telephone | 213-385-1715
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Fax | 213-385-7802
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Provider Business Mailing Address
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Address Line | 1154 S ALVARADO ST
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City | LOS ANGELES
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State | CA
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Zip | 90006-4110
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Country | US
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Telephone | 213-385-1715
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Fax | 213-385-7802
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. CRISTINA BERNARDO MENDOZA
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Credential | BNHA6137
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Telephone | 213-385-1715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 970000064
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License Number State | CA
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