Provider Demographics
NPI:1295976108
Name:MEDIA MOGUL,INC
Entity type:Organization
Organization Name:MEDIA MOGUL,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DU BOC ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:323-375-9973
Mailing Address - Street 1:9029 AIRPORT BLVD
Mailing Address - Street 2:88844
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90009-4801
Mailing Address - Country:US
Mailing Address - Phone:323-375-9973
Mailing Address - Fax:
Practice Address - Street 1:1223 W 127TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-1021
Practice Address - Country:US
Practice Address - Phone:323-375-9973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDIA MOGUL,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition