Provider Demographics
NPI:1003842493
Name:BRIDGET OGWONUWE
Entity Type:Organization
Organization Name:BRIDGET OGWONUWE
Other - Org Name:BRIDGET MEDICAL SUPPLY COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:ADA
Authorized Official - Last Name:OGWONUWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-649-7545
Mailing Address - Street 1:6033 W CENTURY BLVD
Mailing Address - Street 2:SUITE 400 (RM1142)
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-6410
Mailing Address - Country:US
Mailing Address - Phone:310-649-7545
Mailing Address - Fax:310-649-7546
Practice Address - Street 1:6033 W CENTURY BLVD
Practice Address - Street 2:SUITE 400 (RM1142)
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-6410
Practice Address - Country:US
Practice Address - Phone:310-649-7545
Practice Address - Fax:310-649-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43461332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5552320001Medicare NSC