Provider Demographics
NPI:1609594688
Name:ALI MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ALI MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-422-8135
Mailing Address - Street 1:940 ENCHANTED WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0907
Mailing Address - Country:US
Mailing Address - Phone:805-422-8135
Mailing Address - Fax:805-422-8285
Practice Address - Street 1:940 ENCHANTED WAY STE 106
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-0907
Practice Address - Country:US
Practice Address - Phone:805-422-8135
Practice Address - Fax:805-422-8285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies