Provider Demographics
NPI:1184837957
Name:OCB MEDICAL EQUIPMENT AND SUPPLY
Entity Type:Organization
Organization Name:OCB MEDICAL EQUIPMENT AND SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-954-8296
Mailing Address - Street 1:3560 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-4400
Mailing Address - Country:US
Mailing Address - Phone:323-954-8296
Mailing Address - Fax:323-954-8297
Practice Address - Street 1:3560 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-4400
Practice Address - Country:US
Practice Address - Phone:323-954-8296
Practice Address - Fax:323-954-8297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103408332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5058430001Medicare ID - Type Unspecified