MEDICARE: SYCAMORE MEDICAL SUPPLY INC.

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	:	1144375023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYCAMORE MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	7080 HOLLYWOOD BLVD
Second Line	:	STE 920
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6906
Country	:	US
Telephone Number	:	323-465-5654
Fax Number	:	323-465-5398

Provider Business Practice Location Address
First Line	:	7080 HOLLYWOOD BLVD
Second Line	:	STE 920
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6906
Country	:	US
Telephone Number	:	323-465-5654
Fax Number	:	323-465-5398

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANDRANIK MIRZOYAN
Credential	:
Telephone Number	:	323-465-5654

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2020

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