Provider Demographics
NPI:1134303639
Name:A&G MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:A&G MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAPETIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-989-5698
Mailing Address - Street 1:14042 1/2 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2273
Mailing Address - Country:US
Mailing Address - Phone:818-989-5698
Mailing Address - Fax:818-989-5698
Practice Address - Street 1:14042 1/2 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2273
Practice Address - Country:US
Practice Address - Phone:818-989-5698
Practice Address - Fax:818-989-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002280187-001-9332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6075120001Medicare NSC