MEDICARE: PROMISE & DELIVERY MEDICAL SUPPLY

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	5346970001	CA

General Provider Information

NPI Number	:	1669417168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMISE & DELIVERY MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	2338 E ANAHEIM ST
Second Line	:	SUITE 202H
City	:	LONG BEACH
State	:	CA
Zip	:	90804-5730
Country	:	US
Telephone Number	:	562-439-7711
Fax Number	:	562-439-7715

Provider Business Practice Location Address
First Line	:	2338 E ANAHEIM ST
Second Line	:	SUITE 202H
City	:	LONG BEACH
State	:	CA
Zip	:	90804-5730
Country	:	US
Telephone Number	:	562-439-7711
Fax Number	:	562-439-7715

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BABATUNDE AKANDE
Credential	:
Telephone Number	:	562-439-7711

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	06/20/2008

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