Provider Demographics
NPI:1447408620
Name:DURU MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:DURU MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IYKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-789-6100
Mailing Address - Street 1:1704 W MANCHESTER AVE
Mailing Address - Street 2:SUITE 207E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3077
Mailing Address - Country:US
Mailing Address - Phone:323-789-6100
Mailing Address - Fax:323-759-0440
Practice Address - Street 1:1704 W MANCHESTER AVE
Practice Address - Street 2:SUITE 207E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3077
Practice Address - Country:US
Practice Address - Phone:323-789-6100
Practice Address - Fax:323-759-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-30
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50332332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101-121936OtherSELLER'S PERMIT
CA101-121936OtherSELLER'S PERMIT