MEDICARE: EMMANUEL MEDICAL SUPPLY & EQUIPMENT PROVIDER

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	:	1114014453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL MEDICAL SUPPLY & EQUIPMENT PROVIDER

Provider Business Mailing Address
First Line	:	4415 ORCHARD AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-3017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5107 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-3515
Country	:	US
Telephone Number	:	323-971-6270
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	LESLIE DUARTE
Credential	:
Telephone Number	:	323-327-8260

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	08/22/2020

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