Provider Demographics
NPI:1346223633
Name:ASENETE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ASENETE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:UBEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-630-4789
Mailing Address - Street 1:PO BOX 2343
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-0343
Mailing Address - Country:US
Mailing Address - Phone:562-630-4789
Mailing Address - Fax:562-630-6179
Practice Address - Street 1:16444 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5422
Practice Address - Country:US
Practice Address - Phone:562-630-4789
Practice Address - Fax:562-630-6179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103222Medicare ID - Type UnspecifiedFOOD & DRUG LICENSE