Provider Demographics
NPI:1083831077
Name:DESTINY MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:DESTINY MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:OMUVWIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-672-1002
Mailing Address - Street 1:301 N PRAIRIE AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4507
Mailing Address - Country:US
Mailing Address - Phone:310-672-1002
Mailing Address - Fax:310-672-1074
Practice Address - Street 1:301 N PRAIRIE AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4507
Practice Address - Country:US
Practice Address - Phone:310-672-1002
Practice Address - Fax:310-672-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46871332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies