Provider Demographics
NPI:1649384025
Name:BRITE SPOT INC.
Entity Type:Organization
Organization Name:BRITE SPOT INC.
Other - Org Name:BRITE SPOT MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADELEKE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOGAJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-881-7594
Mailing Address - Street 1:18840 VENTURA BLVD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3301
Mailing Address - Country:US
Mailing Address - Phone:818-881-7594
Mailing Address - Fax:818-881-7597
Practice Address - Street 1:18840 VENTURA BLVD
Practice Address - Street 2:SUITE 218
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3301
Practice Address - Country:US
Practice Address - Phone:818-881-7594
Practice Address - Fax:818-881-7597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43179332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5412230001Medicare NSC