Provider Demographics
NPI:1326158247
Name:CORDELIA EZE
Entity Type:Organization
Organization Name:CORDELIA EZE
Other - Org Name:UJ MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:OBIANUJU
Authorized Official - Middle Name:CORDELIA
Authorized Official - Last Name:EZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-603-0512
Mailing Address - Street 1:1315 N BULLIS RD
Mailing Address - Street 2:SUITE 12 E-F
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-1650
Mailing Address - Country:US
Mailing Address - Phone:310-603-0512
Mailing Address - Fax:310-603-0512
Practice Address - Street 1:1315 N BULLIS RD
Practice Address - Street 2:SUITE 12 E-F
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-1650
Practice Address - Country:US
Practice Address - Phone:310-603-0512
Practice Address - Fax:310-603-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45058332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45058OtherINSTATE DMEPOS
CA45058OtherINSTATE DMEPOS