Provider Demographics
NPI:1891831681
Name:ADLIFE MEDICAL SUPPLY & EQUIPMENT INC
Entity Type:Organization
Organization Name:ADLIFE MEDICAL SUPPLY & EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER C.E.O
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:MASA
Authorized Official - Last Name:BACOLOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-809-0281
Mailing Address - Street 1:11436 ARTESIA BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-3859
Mailing Address - Country:US
Mailing Address - Phone:562-809-0281
Mailing Address - Fax:562-809-0194
Practice Address - Street 1:11436 ARTESIA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-3859
Practice Address - Country:US
Practice Address - Phone:562-809-0281
Practice Address - Fax:562-809-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3880830001Medicare ID - Type Unspecified