MEDICARE: PITAL MEDICAL, 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

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	:	1487725016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PITAL MEDICAL, INC.

Provider Business Mailing Address
First Line	:	333 S GRAND AVE STE 3310
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90071-1538
Country	:	US
Telephone Number	:	866-904-4171
Fax Number	:	866-724-3130

Provider Business Practice Location Address
First Line	:	333 S GRAND AVE STE 3310
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90071-1538
Country	:	US
Telephone Number	:	866-904-4171
Fax Number	:	866-724-3130

Authorized Official
Title or Position	:	CEO
Name	:	MS. ROLANDA TERICA BREAUX
Credential	:	COP,CMF
Telephone Number	:	866-904-4171

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	03/02/2022

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Directions to “PITAL MEDICAL, INC. ” Practice Location

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