Provider Demographics
NPI:1477572113
Name:ANGELS PARADISE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ANGELS PARADISE MEDICAL SUPPLY
Other - Org Name:ANGELS PARADISE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUSEGUN
Authorized Official - Middle Name:JOSIAH
Authorized Official - Last Name:AWOYOMI-SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:818-891-8078
Mailing Address - Street 1:8774 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-5158
Mailing Address - Country:US
Mailing Address - Phone:818-891-8078
Mailing Address - Fax:818-891-5525
Practice Address - Street 1:8774 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5158
Practice Address - Country:US
Practice Address - Phone:818-891-8078
Practice Address - Fax:818-891-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45421332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5728930001Medicare NSC