MEDICARE: MEDICALSHOPPE.COM, 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	44021	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265488522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICALSHOPPE.COM, INC.

Provider Business Mailing Address
First Line	:	2501 COLORADO BLVD
Second Line	:	SUITE H
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1055
Country	:	US
Telephone Number	:	323-340-3962
Fax Number	:	323-340-3963

Provider Business Practice Location Address
First Line	:	2501 COLORADO BLVD
Second Line	:	SUITE H
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1055
Country	:	US
Telephone Number	:	323-340-3962
Fax Number	:	323-340-3963

Authorized Official
Title or Position	:	CEO
Name	:	MR. WILSON A MARTINEZ
Credential	:	BSC, LLB
Telephone Number	:	323-340-3962

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/22/2020

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