Provider Demographics
NPI:1922134204
Name:AGP MEDICAL CORPORATION
Entity Type:Organization
Organization Name:AGP MEDICAL CORPORATION
Other - Org Name:ADVANTAGE 1 MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:VERRETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEOROSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-492-5994
Mailing Address - Street 1:169 E 36TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3852
Mailing Address - Country:US
Mailing Address - Phone:562-492-5994
Mailing Address - Fax:310-649-1404
Practice Address - Street 1:848 W 115TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4112
Practice Address - Country:US
Practice Address - Phone:562-492-5994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies