Provider Demographics
NPI:1376729699
Name:AVANGARD SOUZ BUSINESS, INC.
Entity Type:Organization
Organization Name:AVANGARD SOUZ BUSINESS, INC.
Other - Org Name:LONG LIFE MEDICAL HEALTH SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:AROUTYUONIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-799-9555
Mailing Address - Street 1:23120 LYONS AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2668
Mailing Address - Country:US
Mailing Address - Phone:661-799-9555
Mailing Address - Fax:661-799-0553
Practice Address - Street 1:23120 LYONS AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2668
Practice Address - Country:US
Practice Address - Phone:661-799-9555
Practice Address - Fax:661-799-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48761332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1376729699Medicaid
CA6076340001Medicare NSC