MEDICARE: HUB ZONE ENTERPRISES, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1205422185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUB ZONE ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	1617 N EL CENTRO AVE STE 19
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 N EL CENTRO AVE STE 19
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6429
Country	:	US
Telephone Number	:	323-432-0306
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	VICTORIA BOSMAN
Credential	:
Telephone Number	:	323-432-0306

Provider Enumeration Date	:	12/15/2020
Last Update Date	:	12/15/2020

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