Provider Demographics
NPI:1710085162
Name:GRANT OTUZBIRYAN
Entity Type:Organization
Organization Name:GRANT OTUZBIRYAN
Other - Org Name:SUNLAND MEDICAL SUPPLY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:OTUZBIRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-352-9880
Mailing Address - Street 1:8530 FOOTHILL BLVD
Mailing Address - Street 2:SUITE # E
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-1900
Mailing Address - Country:US
Mailing Address - Phone:818-352-9880
Mailing Address - Fax:818-352-9881
Practice Address - Street 1:8530 FOOTHILL BLVD
Practice Address - Street 2:SUITE # E
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-1900
Practice Address - Country:US
Practice Address - Phone:818-352-9880
Practice Address - Fax:818-352-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02721FMedicaid
CA1225910001Medicare NSC