=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992343867
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OXYGEN SERVICES SOUTHWEST LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2019
-----------------------------------------------------
Last Update Date | 12/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13396 CONTOUR DR
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91423-4802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-752-9830
-----------------------------------------------------
Fax | 310-507-0146
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13535 VENTURA BLVD STE C-417
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91423-3876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-752-9830
-----------------------------------------------------
Fax | 310-507-0146
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VINA JOANNE LAGUIO SUMABAT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-752-9830
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------