MEDICARE: NOBLE 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	:	1447306667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOBLE MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	1638 E ARTESIA BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1623
Country	:	US
Telephone Number	:	562-256-2483
Fax Number	:	562-256-2496

Provider Business Practice Location Address
First Line	:	1638 E ARTESIA BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1623
Country	:	US
Telephone Number	:	562-256-2483
Fax Number	:	562-256-2496

Authorized Official
Title or Position	:	MANAGER
Name	:	APPOLONIA UZOAMAKA EZEANIOMA
Credential	:
Telephone Number	:	562-256-2483

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/22/2020

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