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General NPI Number Information
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NPI Number | 1740248475
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Entity Type | Organization
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Legal Business Name | PIONEER MEDICAL SUPPLY SERVICE
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 8221 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90047-3036
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Country | US
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Telephone | 323-778-3815
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Fax | 323-778-3819
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Provider Business Mailing Address
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Address Line | PO BOX 451155
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City | LOS ANGELES
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State | CA
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Zip | 90045-8511
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Country | US
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Telephone | 323-778-3815
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Fax | 323-778-3819
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | BEN AGHA OFFOR
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Credential |
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Telephone | 323-778-3815
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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 | 103149
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License Number State | CA
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