Provider Demographics
NPI:1083641617
Name:ACE MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:ACE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABIJATU
Authorized Official - Middle Name:H
Authorized Official - Last Name:SESAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-676-2060
Mailing Address - Street 1:15030
Mailing Address - Street 2:PRAIRIE AVENUE
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90250
Mailing Address - Country:US
Mailing Address - Phone:310-676-2060
Mailing Address - Fax:310-676-3612
Practice Address - Street 1:15030 PRAIRIE AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:310-676-2060
Practice Address - Fax:310-676-3612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5672260001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5672260001Medicare ID - Type UnspecifiedPROVIDER NO.