Provider Demographics
NPI:1821169376
Name:ARINA MEDICAL SERVICE & SUPPLIES
Entity Type:Organization
Organization Name:ARINA MEDICAL SERVICE & SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-590-1277
Mailing Address - Street 1:313 N LA BREA AVE
Mailing Address - Street 2:AUITE 400
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-3400
Mailing Address - Country:US
Mailing Address - Phone:310-590-1277
Mailing Address - Fax:310-590-1279
Practice Address - Street 1:313 N LA BREA AVE
Practice Address - Street 2:AUITE 400
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-3400
Practice Address - Country:US
Practice Address - Phone:310-590-1277
Practice Address - Fax:310-590-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103271332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4955630001Medicare NSC