Provider Demographics
NPI:1437265469
Name:JONES A OKEKE
Entity Type:Organization
Organization Name:JONES A OKEKE
Other - Org Name:VISTA MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONES
Authorized Official - Middle Name:ANNY
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-954-9820
Mailing Address - Street 1:5017 SAN VICENTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2955
Mailing Address - Country:US
Mailing Address - Phone:323-954-9820
Mailing Address - Fax:323-954-7995
Practice Address - Street 1:5017 SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-2955
Practice Address - Country:US
Practice Address - Phone:323-954-9820
Practice Address - Fax:323-954-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44381332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44381OtherHMDR
CA44381OtherHMDR
CA=========OtherEIN