MEDICARE: BLUE OAK ASSET MANAGEMENT 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	0002888567-0001-5	CA

General Provider Information

NPI Number	:	1265966824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE OAK ASSET MANAGEMENT INC

Provider Business Mailing Address
First Line	:	5860 AVALON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1308
Country	:	US
Telephone Number	:	909-204-6612
Fax Number	:

Provider Business Practice Location Address
First Line	:	5860 AVALON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-1308
Country	:	US
Telephone Number	:	909-204-6612
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHANNON MOORE
Credential	:
Telephone Number	:	562-506-5215

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	04/20/2017

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