MEDICARE: PRO CARE DME SUPPLIES

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	103745	CA

General Provider Information

NPI Number	:	1093752578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO CARE DME SUPPLIES

Provider Business Mailing Address
First Line	:	3401 GLENDALE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1814
Country	:	US
Telephone Number	:	323-661-6533
Fax Number	:	323-661-6524

Provider Business Practice Location Address
First Line	:	3401 GLENDALE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1814
Country	:	US
Telephone Number	:	323-661-6533
Fax Number	:	323-661-6524

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AVET GEVORGYAN
Credential	:
Telephone Number	:	323-661-6533

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	01/26/2008

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