Provider Demographics
NPI:1669417168
Name:PROMISE & DELIVERY MEDICAL SUPPLY
Entity type:Organization
Organization Name:PROMISE & DELIVERY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BABATUNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-439-7711
Mailing Address - Street 1:2338 E ANAHEIM ST
Mailing Address - Street 2:SUITE 202H
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-5730
Mailing Address - Country:US
Mailing Address - Phone:562-439-7711
Mailing Address - Fax:562-439-7715
Practice Address - Street 1:2338 E ANAHEIM ST
Practice Address - Street 2:SUITE 202H
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-5730
Practice Address - Country:US
Practice Address - Phone:562-439-7711
Practice Address - Fax:562-439-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5346970001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5346970001Medicare ID - Type UnspecifiedPROVIDER NUMBER