MEDICARE: REGAL MEDICAL SUPPLIES 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	45166	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45166	OTHER	CA	HMDR LICENSE

General Provider Information

NPI Number	:	1790896793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGAL MEDICAL SUPPLIES INC

Provider Business Mailing Address
First Line	:	PO BOX 431184
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-9184
Country	:	US
Telephone Number	:	323-298-4733
Fax Number	:	323-298-4744

Provider Business Practice Location Address
First Line	:	4336 11TH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-5205
Country	:	US
Telephone Number	:	323-298-4733
Fax Number	:	323-298-4744

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SHAIBU ONOGIMESIKE OBAKHUME
Credential	:
Telephone Number	:	323-298-4733

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/09/2010

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