Provider Demographics
NPI:1255926978
Name:VERDUGO MEDICAL SUPPLY
Entity type:Organization
Organization Name:VERDUGO MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADAREVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-244-5497
Mailing Address - Street 1:PO BOX 452
Mailing Address - Street 2:
Mailing Address - City:VERDUGO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91046-0452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2837 HONOLULU AVE
Practice Address - Street 2:
Practice Address - City:VERDUGO
Practice Address - State:CA
Practice Address - Zip Code:91046
Practice Address - Country:US
Practice Address - Phone:818-244-5497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies