Provider Demographics
NPI:1831302850
Name:COLGATE MEDICAL AND SURGICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:COLGATE MEDICAL AND SURGICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGANOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-782-0145
Mailing Address - Street 1:425 S FAIRFAX AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3148
Mailing Address - Country:US
Mailing Address - Phone:323-782-0145
Mailing Address - Fax:323-782-0273
Practice Address - Street 1:425 S FAIRFAX AVE STE 209
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3148
Practice Address - Country:US
Practice Address - Phone:323-782-0145
Practice Address - Fax:323-782-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52093332B00000X, 332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAM120227OtherFURNITURE & BEDDING RETAI
CA0443540001OtherMEDICARE PTAN
CA52093OtherHMDR LICENSE