Provider Demographics
NPI:1255482758
Name:UC MEDICAL SUPPLY
Entity Type:Organization
Organization Name:UC MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NORAIR
Authorized Official - Middle Name:G
Authorized Official - Last Name:BEZIKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-876-3407
Mailing Address - Street 1:3535 CAHUENGA BLVD W STE 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1359
Mailing Address - Country:US
Mailing Address - Phone:323-876-3407
Mailing Address - Fax:323-876-3629
Practice Address - Street 1:3535 CAHUENGA BLVD W STE 203
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1359
Practice Address - Country:US
Practice Address - Phone:323-876-3407
Practice Address - Fax:323-876-3629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02418FMedicaid
CA4052140001Medicare NSC