Provider Demographics
NPI:1407472475
Name:SIGNATURE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:SIGNATURE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHABALYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-206-8600
Mailing Address - Street 1:20847 SHERMAN WAY # 120
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2706
Mailing Address - Country:US
Mailing Address - Phone:818-206-8600
Mailing Address - Fax:818-377-7551
Practice Address - Street 1:20847 SHERMAN WAY # 102
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2706
Practice Address - Country:US
Practice Address - Phone:818-206-8600
Practice Address - Fax:818-377-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies