Provider Demographics
NPI:1770510869
Name:MILLENNIUM MEDICAL PRODUCTS INC
Entity Type:Organization
Organization Name:MILLENNIUM MEDICAL PRODUCTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VARDAN
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:GILAVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:818-840-8061
Mailing Address - Street 1:2300 W.VICTORY BL ST.B
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506
Mailing Address - Country:US
Mailing Address - Phone:818-840-8061
Mailing Address - Fax:818-840-8062
Practice Address - Street 1:2300 W VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1256
Practice Address - Country:US
Practice Address - Phone:818-840-8061
Practice Address - Fax:818-840-8062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43580332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5409450001Medicare NSC