Provider Demographics
NPI:1427217413
Name:MONTEBELLO MEDICAL SUPPLY,INC.
Entity Type:Organization
Organization Name:MONTEBELLO MEDICAL SUPPLY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:SUPPLIER
Authorized Official - Phone:1323-722-2900
Mailing Address - Street 1:1800 W BEVERLY BLVD
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3963
Mailing Address - Country:US
Mailing Address - Phone:323-722-2900
Mailing Address - Fax:323-516-6227
Practice Address - Street 1:1800 W BEVERLY BLVD
Practice Address - Street 2:SUITE # 101
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3963
Practice Address - Country:US
Practice Address - Phone:323-722-2900
Practice Address - Fax:323-516-6227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTEBELLO MEDICA SUPPLY,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-04
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48847332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6108630002Medicare NSC