Provider Demographics
NPI:1265477004
Name:T A MEDICAL SUPPLY
Entity Type:Organization
Organization Name:T A MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELKON
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIYELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-352-6810
Mailing Address - Street 1:3514 COMMUNITY AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2522
Mailing Address - Country:US
Mailing Address - Phone:818-249-2919
Mailing Address - Fax:
Practice Address - Street 1:7906 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2937
Practice Address - Country:US
Practice Address - Phone:818-352-6810
Practice Address - Fax:818-352-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4885500001Medicare ID - Type Unspecified