Provider Demographics
NPI:1942403068
Name:DEBS MEDICAL DISTRIBUTORS INC
Entity Type:Organization
Organization Name:DEBS MEDICAL DISTRIBUTORS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SOGBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-376-1243
Mailing Address - Street 1:13615 VICTORY BLVD STE 136
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1737
Mailing Address - Country:US
Mailing Address - Phone:818-376-1243
Mailing Address - Fax:
Practice Address - Street 1:13615 VICTORY BLVD STE 136
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1737
Practice Address - Country:US
Practice Address - Phone:818-376-1243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47458332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6119390001Medicare NSC