MEDICARE: HOLY CROSS MEDICAL EQUIPMENT SUPPLIES

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	:	1689632481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLY CROSS MEDICAL EQUIPMENT SUPPLIES

Provider Business Mailing Address
First Line	:	4754 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-1526
Country	:	US
Telephone Number	:	323-933-6888
Fax Number	:	323-933-0054

Provider Business Practice Location Address
First Line	:	4754 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-1526
Country	:	US
Telephone Number	:	323-933-6888
Fax Number	:	323-933-0054

Authorized Official
Title or Position	:	MANAGER
Name	:	SUNDAY A NYENKE
Credential	:
Telephone Number	:	323-933-6888

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	08/22/2020

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