Provider Demographics
NPI:1831587542
Name:OC MEDICAL SUPPLY INCORPORATED
Entity type:Organization
Organization Name:OC MEDICAL SUPPLY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OJO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:949-825-7947
Mailing Address - Street 1:2 JENNER STE 120
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3832
Mailing Address - Country:US
Mailing Address - Phone:949-825-7947
Mailing Address - Fax:949-825-7949
Practice Address - Street 1:2 JENNER STE 120
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3832
Practice Address - Country:US
Practice Address - Phone:949-825-7947
Practice Address - Fax:949-825-7949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OC MEDICAL SUPPLY INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-05
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45849332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5775320001Medicare NSC