MEDICARE: ACTIVE MEDICAL EQUIPMENT & SUPPLIS

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	103338	CA

General Provider Information

NPI Number	:	1619993029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE MEDICAL EQUIPMENT & SUPPLIS

Provider Business Mailing Address
First Line	:	1704 W MANCHESTER AVE
Second Line	:	SUITE 204D
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-3034
Country	:	US
Telephone Number	:	323-758-7550
Fax Number	:	323-758-5550

Provider Business Practice Location Address
First Line	:	1704 W MANCHESTER AVE
Second Line	:	SUITE 204D
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-3034
Country	:	US
Telephone Number	:	323-758-7550
Fax Number	:	323-758-5550

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	MR. ALULA BEKELE BERHANE
Credential	:
Telephone Number	:	310-714-9667

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	07/21/2022

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