MEDICARE: COMFORT SHOES AND MED EQUIPMENT CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	48058	CA

General Provider Information

NPI Number	:	1063691707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT SHOES AND MED EQUIPMENT CORPORATION

Provider Business Mailing Address
First Line	:	5065 HOLLYWOOD BLVD
Second Line	:	SUITE 104
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6133
Country	:	US
Telephone Number	:	323-668-1777
Fax Number	:	323-668-1771

Provider Business Practice Location Address
First Line	:	5065 HOLLYWOOD BLVD
Second Line	:	SUITE 104
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6133
Country	:	US
Telephone Number	:	323-668-1777
Fax Number	:	323-668-1771

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NUBAR TRDATYAN
Credential	:
Telephone Number	:	323-668-1777

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	03/06/2008

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