Provider Demographics
NPI:1265625081
Name:SEBOL MEDICAL SUPPLIES
Entity type:Organization
Organization Name:SEBOL MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLATUNBOSUN
Authorized Official - Middle Name:ABIODUN
Authorized Official - Last Name:OSHUNLUYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-419-3061
Mailing Address - Street 1:318 E HILLCREST BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-2406
Mailing Address - Country:US
Mailing Address - Phone:310-419-3061
Mailing Address - Fax:310-419-3062
Practice Address - Street 1:318 E HILLCREST BLVD
Practice Address - Street 2:STE 2
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2406
Practice Address - Country:US
Practice Address - Phone:310-419-3061
Practice Address - Fax:310-419-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6032300001Medicare NSC