MEDICARE: GOLDEN AGE MEDICAL EQUIPMENT AND 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	44989	CA

General Provider Information

NPI Number	:	1821035668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN AGE MEDICAL EQUIPMENT AND SUPPLY

Provider Business Mailing Address
First Line	:	7121 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4411
Country	:	US
Telephone Number	:	323-876-5537
Fax Number	:	323-876-5573

Provider Business Practice Location Address
First Line	:	7121 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4411
Country	:	US
Telephone Number	:	323-876-5537
Fax Number	:	323-876-5573

Authorized Official
Title or Position	:	CEO
Name	:	SVETLANA ROMANCHUK
Credential	:
Telephone Number	:	323-876-5537

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	04/23/2010

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