MEDICARE: MEDICALSTATIONSUPPLY

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

General Provider Information

NPI Number	:	1073752820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICALSTATIONSUPPLY

Provider Business Mailing Address
First Line	:	120 N ELM DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-5510
Country	:	US
Telephone Number	:	310-279-0624
Fax Number	:	213-612-4936

Provider Business Practice Location Address
First Line	:	1143 S LOS ANGELES ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-2536
Country	:	US
Telephone Number	:	310-770-7309
Fax Number	:	213-612-4936

Authorized Official
Title or Position	:	TREASURER
Name	:	DANIEL AZIZI
Credential	:
Telephone Number	:	310-279-0642

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	02/18/2009

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