MEDICARE: G&A SENIOR CARE

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	:	1508065616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G&A SENIOR CARE

Provider Business Mailing Address
First Line	:	1749 POTRERO GRANDE DR
Second Line	:	SUITE#A1
City	:	MONTEREY PARK
State	:	CA
Zip	:	91755-5859
Country	:	US
Telephone Number	:	626-280-0200
Fax Number	:	626-280-0205

Provider Business Practice Location Address
First Line	:	1749 POTRERO GRANDE DR
Second Line	:	SUITE#A1
City	:	MONTEREY PARK
State	:	CA
Zip	:	91755-5859
Country	:	US
Telephone Number	:	626-280-0200
Fax Number	:	626-280-0205

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GABRIEL MENA
Credential	:
Telephone Number	:	626-280-0200

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	01/11/2008

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