Provider Demographics
NPI:1366501322
Name:MAZSA CORPORATION
Entity Type:Organization
Organization Name:MAZSA CORPORATION
Other - Org Name:MAZSA MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:OLATUNDE
Authorized Official - Last Name:SHEKONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-373-9868
Mailing Address - Street 1:1818 S WESTERN AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-5807
Mailing Address - Country:US
Mailing Address - Phone:323-373-9868
Mailing Address - Fax:323-954-7424
Practice Address - Street 1:1818 S WESTERN AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5807
Practice Address - Country:US
Practice Address - Phone:323-373-9868
Practice Address - Fax:323-954-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46250332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5913820001Medicare NSC