Provider Demographics
NPI:1255509931
Name:AYAH'S MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:AYAH'S MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NEDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SETABOUHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-970-7900
Mailing Address - Street 1:13335 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5802
Mailing Address - Country:US
Mailing Address - Phone:310-970-7900
Mailing Address - Fax:310-970-7901
Practice Address - Street 1:13335 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5802
Practice Address - Country:US
Practice Address - Phone:310-970-7900
Practice Address - Fax:310-970-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48463332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6093240001OtherMEDICARE SUPPLIER NUMBER
CA6093240001Medicare NSC