Provider Demographics
NPI:1790794287
Name:PASCON
Entity Type:Organization
Organization Name:PASCON
Other - Org Name:PASCON MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:IRUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-295-9009
Mailing Address - Street 1:5700 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2410
Mailing Address - Country:US
Mailing Address - Phone:323-295-9009
Mailing Address - Fax:323-295-9007
Practice Address - Street 1:5700 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2410
Practice Address - Country:US
Practice Address - Phone:323-295-9009
Practice Address - Fax:323-295-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102214332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45-989-00001Medicare NSC