Provider Demographics
NPI:1043245616
Name:NDUBUISI O CHIJIOKE
Entity Type:Organization
Organization Name:NDUBUISI O CHIJIOKE
Other - Org Name:COMMONWEALTH MEDICAL SUPPLY COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NDUBUISI
Authorized Official - Middle Name:OGBONNAYA
Authorized Official - Last Name:CHIJIOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-832-1920
Mailing Address - Street 1:16225 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6910
Mailing Address - Country:US
Mailing Address - Phone:818-832-1920
Mailing Address - Fax:818-832-1921
Practice Address - Street 1:16225 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6910
Practice Address - Country:US
Practice Address - Phone:818-832-1920
Practice Address - Fax:818-832-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17348332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4060320001Medicare ID - Type UnspecifiedMEDICARE BILLING NUMBER