Provider Demographics
NPI:1093858086
Name:TANA MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:TANA MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FENTAHUN
Authorized Official - Middle Name:B
Authorized Official - Last Name:FEREDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-734-7881
Mailing Address - Street 1:1828 S WESTERN AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-5808
Mailing Address - Country:US
Mailing Address - Phone:323-734-7881
Mailing Address - Fax:323-734-7882
Practice Address - Street 1:1828 S WESTERN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5808
Practice Address - Country:US
Practice Address - Phone:323-734-7881
Practice Address - Fax:323-734-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46702332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies