Provider Demographics
NPI:1790882975
Name:U.S. MEDTRADE CO., INC.
Entity Type:Organization
Organization Name:U.S. MEDTRADE CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-557-8379
Mailing Address - Street 1:519 N VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1737
Mailing Address - Country:US
Mailing Address - Phone:818-557-8379
Mailing Address - Fax:818-557-8378
Practice Address - Street 1:519 N VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1737
Practice Address - Country:US
Practice Address - Phone:818-557-8379
Practice Address - Fax:818-557-8378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03400FMedicaid
CA5838750001Medicare NSC