Provider Demographics
NPI:1497701080
Name:CHUMA NWAKO
Entity Type:Organization
Organization Name:CHUMA NWAKO
Other - Org Name:PACIFICA MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-630-1600
Mailing Address - Street 1:PO BOX 88121
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90009-8121
Mailing Address - Country:US
Mailing Address - Phone:310-630-1600
Mailing Address - Fax:310-630-1661
Practice Address - Street 1:15238 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4049
Practice Address - Country:US
Practice Address - Phone:310-630-1600
Practice Address - Fax:310-630-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45425332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5714210001Medicare NSC