Provider Demographics
NPI:1073752820
Name:MEDICALSTATIONSUPPLY
Entity Type:Organization
Organization Name:MEDICALSTATIONSUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-279-0642
Mailing Address - Street 1:120 N ELM DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5510
Mailing Address - Country:US
Mailing Address - Phone:310-279-0624
Mailing Address - Fax:213-612-4936
Practice Address - Street 1:1143 S LOS ANGELES ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2536
Practice Address - Country:US
Practice Address - Phone:310-770-7309
Practice Address - Fax:213-612-4936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies