Provider Demographics
NPI:1619993029
Name:ACTIVE MEDICAL EQUIPMENT & SUPPLIS
Entity Type:Organization
Organization Name:ACTIVE MEDICAL EQUIPMENT & SUPPLIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALULA
Authorized Official - Middle Name:BEKELE
Authorized Official - Last Name:BERHANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-714-9667
Mailing Address - Street 1:1704 W MANCHESTER AVE
Mailing Address - Street 2:SUITE 204D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3034
Mailing Address - Country:US
Mailing Address - Phone:323-758-7550
Mailing Address - Fax:323-758-5550
Practice Address - Street 1:1704 W MANCHESTER AVE
Practice Address - Street 2:SUITE 204D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3034
Practice Address - Country:US
Practice Address - Phone:323-758-7550
Practice Address - Fax:323-758-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103338332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies