Provider Demographics
NPI:1669701090
Name:EL MONTE NUTRITIONAL AND MEDICAL SUPPLIES
Entity type:Organization
Organization Name:EL MONTE NUTRITIONAL AND MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISHAK
Authorized Official - Middle Name:NZ
Authorized Official - Last Name:BISHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-442-5015
Mailing Address - Street 1:2002 DURFEE AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-3713
Mailing Address - Country:US
Mailing Address - Phone:626-975-9712
Mailing Address - Fax:626-442-7810
Practice Address - Street 1:2002 DURFEE AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3713
Practice Address - Country:US
Practice Address - Phone:626-975-9712
Practice Address - Fax:626-442-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies