Provider Demographics
NPI:1225048705
Name:OLOO MEDICAL SUPPLY
Entity Type:Organization
Organization Name:OLOO MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EJIBE
Authorized Official - Middle Name:O
Authorized Official - Last Name:OKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-679-4106
Mailing Address - Street 1:15675 HAWTHORNE BLVD
Mailing Address - Street 2:UNIT D
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2659
Mailing Address - Country:US
Mailing Address - Phone:310-679-4106
Mailing Address - Fax:310-679-4164
Practice Address - Street 1:15675 HAWTHORNE BLVD
Practice Address - Street 2:UNIT D
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2659
Practice Address - Country:US
Practice Address - Phone:310-679-4106
Practice Address - Fax:310-679-4164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06922332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5996140001Medicare NSC