Provider Demographics
NPI:1336327360
Name:GOLDEN LIFE MEDICAL DISTRIBUTORS
Entity Type:Organization
Organization Name:GOLDEN LIFE MEDICAL DISTRIBUTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NGOKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-219-1612
Mailing Address - Street 1:11502 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2314
Mailing Address - Country:US
Mailing Address - Phone:310-219-1612
Mailing Address - Fax:310-219-1864
Practice Address - Street 1:11502 HAWTHORNE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2314
Practice Address - Country:US
Practice Address - Phone:310-219-1612
Practice Address - Fax:310-219-1864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46986332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46986OtherHMDR
CA=========OtherEIN
CA46986OtherHMDR