Provider Demographics
NPI:1710966015
Name:RIFATS MEDICAL SUPPLY
Entity Type:Organization
Organization Name:RIFATS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:ABOLAJI
Authorized Official - Last Name:ISAACS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-404-9693
Mailing Address - Street 1:916 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-2345
Mailing Address - Country:US
Mailing Address - Phone:310-419-4206
Mailing Address - Fax:310-419-8011
Practice Address - Street 1:916 N MARKET ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-2345
Practice Address - Country:US
Practice Address - Phone:310-419-4206
Practice Address - Fax:310-419-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43358332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5432960001Medicare ID - Type Unspecified