Provider Demographics
NPI:1184698631
Name:ELITE MEDICAL DISTRIBUTORS
Entity type:Organization
Organization Name:ELITE MEDICAL DISTRIBUTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:OWUMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-323-2305
Mailing Address - Street 1:4549 W ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6935
Mailing Address - Country:US
Mailing Address - Phone:310-970-9600
Mailing Address - Fax:310-970-9669
Practice Address - Street 1:4549 W ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6935
Practice Address - Country:US
Practice Address - Phone:310-970-9600
Practice Address - Fax:310-970-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103556332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5246420001Medicare NSC