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General NPI Number Information
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NPI Number | 1770954471
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Entity Type | Organization
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Legal Business Name | PRUDENT MEDICAL SUPPLIES INC
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 5250 W CENTURY BLVD SUITE 216
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City | LOS ANGELES
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State | CA
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Zip | 90045-5972
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Country | US
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Telephone | 424-331-5400
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Fax | 424-331-5933
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Provider Business Mailing Address
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Address Line | 5250 W CENTURY BLVD SUITE 216
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City | LOS ANGELES
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State | CA
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Zip | 90045-5972
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Country | US
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Telephone | 424-331-5400
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Fax | 424-331-5933
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRUCK MENGISTU
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Credential |
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Telephone | 424-331-5400
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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 | 74463
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License Number State | CA
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