Provider Demographics
NPI:1811100803
Name:LUSTER MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:LUSTER MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEVORG
Authorized Official - Middle Name:
Authorized Official - Last Name:MINASYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-255-4944
Mailing Address - Street 1:13136 SATICOY ST STE M
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-3430
Mailing Address - Country:US
Mailing Address - Phone:818-255-4944
Mailing Address - Fax:818-255-4966
Practice Address - Street 1:13136 SATICOY ST STE M
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-3430
Practice Address - Country:US
Practice Address - Phone:818-255-4944
Practice Address - Fax:818-255-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies