MEDICARE: ICEBERG HEALTH CARE 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		CA

General Provider Information

NPI Number	:	1265545958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICEBERG HEALTH CARE INC.

Provider Business Mailing Address
First Line	:	3631 CRENSHAW BLVD STE 111
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4869
Country	:	US
Telephone Number	:	323-733-5153
Fax Number	:	323-733-5142

Provider Business Practice Location Address
First Line	:	3631 CRENSHAW BLVD STE 111
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4869
Country	:	US
Telephone Number	:	323-733-5153
Fax Number	:	323-733-5142

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDERY YEVCHUK
Credential	:
Telephone Number	:	323-733-5153

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	08/22/2020

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