Provider Demographics
NPI:1437231487
Name:OSEKH-ED CORPORATION
Entity Type:Organization
Organization Name:OSEKH-ED CORPORATION
Other - Org Name:DEVINE ANGEL MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:OSEKHODION
Authorized Official - Last Name:EDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-654-9899
Mailing Address - Street 1:17727 VANOWEN ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-5602
Mailing Address - Country:US
Mailing Address - Phone:818-654-9899
Mailing Address - Fax:818-654-9891
Practice Address - Street 1:17727 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-5602
Practice Address - Country:US
Practice Address - Phone:818-654-9899
Practice Address - Fax:818-654-9891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103714332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03375FMedicaid
CADME03375FMedicaid