Provider Demographics
NPI:1841616018
Name:MARTIN LUTHER VOCATIONAL CENTER, INC
Entity Type:Organization
Organization Name:MARTIN LUTHER VOCATIONAL CENTER, INC
Other - Org Name:LA MEDICAL STORE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAULINUS
Authorized Official - Middle Name:
Authorized Official - Last Name:NDIBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-639-3975
Mailing Address - Street 1:428 S ROSEMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107
Mailing Address - Country:US
Mailing Address - Phone:626-639-3975
Mailing Address - Fax:626-639-3975
Practice Address - Street 1:428 S ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107
Practice Address - Country:US
Practice Address - Phone:626-639-3875
Practice Address - Fax:626-639-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
No335G00000XSuppliersMedical Foods Supplier
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier