Provider Demographics
NPI:1972545259
Name:SAFAR MANSOOR
Entity Type:Organization
Organization Name:SAFAR MANSOOR
Other - Org Name:FEROZ MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAFAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANSOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-263-3804
Mailing Address - Street 1:3655 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-2441
Mailing Address - Country:US
Mailing Address - Phone:323-263-3804
Mailing Address - Fax:323-263-3875
Practice Address - Street 1:3655 E 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-2441
Practice Address - Country:US
Practice Address - Phone:323-263-3804
Practice Address - Fax:323-263-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102686332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4890170001Medicare NSC