Provider Demographics
NPI:1962628065
Name:NATIONAL TRACER SERVICE & ENTERPRISE
Entity Type:Organization
Organization Name:NATIONAL TRACER SERVICE & ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:EYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-294-6941
Mailing Address - Street 1:PO BOX 431361
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-9361
Mailing Address - Country:US
Mailing Address - Phone:323-294-6941
Mailing Address - Fax:323-294-6942
Practice Address - Street 1:4025 MARLTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008
Practice Address - Country:US
Practice Address - Phone:323-294-6941
Practice Address - Fax:323-294-6942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4601120001OtherPROVIDER NUMBER