MEDICARE: SUN VALLEY MEDICAL DEVICES 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	102977	CA

General Provider Information

NPI Number	:	1669555678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN VALLEY MEDICAL DEVICES INC.

Provider Business Mailing Address
First Line	:	3629 N SEPULVEDA BLVD
Second Line	:	SUITE 103
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-3632
Country	:	US
Telephone Number	:	424-247-7308
Fax Number	:	866-617-1708

Provider Business Practice Location Address
First Line	:	3629 N SEPULVEDA BLVD
Second Line	:	103
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-3632
Country	:	US
Telephone Number	:	424-247-7308
Fax Number	:	866-617-1708

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DIANE GEORGINA HENDERSON
Credential	:
Telephone Number	:	424-247-7308

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	09/06/2011

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