Provider Demographics
NPI:1710192877
Name:SCIENCE AGE MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:SCIENCE AGE MEDICAL SUPPLIES INC
Other - Org Name:SCIENCE AGE MEDICAL SUPPLIES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:N
Authorized Official - Last Name:AHUMIBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-385-6256
Mailing Address - Street 1:3660 WILSHIRE BLVD #924
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2705
Mailing Address - Country:US
Mailing Address - Phone:213-385-6256
Mailing Address - Fax:213-385-6182
Practice Address - Street 1:3660 WILSHIRE BLVD #924
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2705
Practice Address - Country:US
Practice Address - Phone:213-385-6256
Practice Address - Fax:213-385-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASRAS97595651332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03086FMedicaid