Provider Demographics
NPI:1780861187
Name:MED1SPECIALTIES, INC.
Entity Type:Organization
Organization Name:MED1SPECIALTIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ROSCA
Authorized Official - Last Name:ANTONINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-988-6290
Mailing Address - Street 1:16022 ARMINTA STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406
Mailing Address - Country:US
Mailing Address - Phone:818-988-6290
Mailing Address - Fax:818-988-6271
Practice Address - Street 1:16022 ARMINTA STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406
Practice Address - Country:US
Practice Address - Phone:818-988-6290
Practice Address - Fax:818-988-6271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103448332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies