Provider Demographics
NPI:1487796785
Name:COMPLETE MEDICAL EQUIPMENT AND SUPPLIES
Entity type:Organization
Organization Name:COMPLETE MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AFEWORK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-992-3402
Mailing Address - Street 1:20944 SHERMAN WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1747
Mailing Address - Country:US
Mailing Address - Phone:818-992-3402
Mailing Address - Fax:818-992-3407
Practice Address - Street 1:20944 SHERMAN WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1747
Practice Address - Country:US
Practice Address - Phone:818-992-3402
Practice Address - Fax:818-992-3407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03237FMedicaid
CADME03237FMedicaid