Provider Demographics
NPI:1497960587
Name:SANTA ANITA MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:SANTA ANITA MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHEREGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-442-2650
Mailing Address - Street 1:4424 SANTA ANITA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1684
Mailing Address - Country:US
Mailing Address - Phone:866-559-2545
Mailing Address - Fax:626-442-3461
Practice Address - Street 1:4424 SANTA ANITA AVE STE 104
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1684
Practice Address - Country:US
Practice Address - Phone:866-559-2545
Practice Address - Fax:626-442-3461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6033610001Medicare NSC