MEDICARE: RIFATS 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	332BC3200X	Customized Equipment (DME)	43358	CA

General Provider Information

NPI Number	:	1710966015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIFATS MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	916 N MARKET ST
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90302-2345
Country	:	US
Telephone Number	:	310-419-4206
Fax Number	:	310-419-8011

Provider Business Practice Location Address
First Line	:	916 N MARKET ST
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90302-2345
Country	:	US
Telephone Number	:	310-419-4206
Fax Number	:	310-419-8011

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KELVIN ABOLAJI ISAACS
Credential	:
Telephone Number	:	310-404-9693

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	07/07/2008

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Directions to “RIFATS MEDICAL SUPPLY ” Practice Location

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