Provider Demographics
NPI:1487749008
Name:SANTOS MEDICAL SUPPLY & EQUIMPENT PROVIDER
Entity type:Organization
Organization Name:SANTOS MEDICAL SUPPLY & EQUIMPENT PROVIDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-732-3798
Mailing Address - Street 1:2821 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2230
Mailing Address - Country:US
Mailing Address - Phone:323-732-3798
Mailing Address - Fax:323-732-5034
Practice Address - Street 1:2821 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2230
Practice Address - Country:US
Practice Address - Phone:323-732-3798
Practice Address - Fax:323-732-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5184410001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5184410001Medicare NSC