Provider Demographics
NPI:1881625556
Name:COLONIAL MEDICAL SUPPLY
Entity type:Organization
Organization Name:COLONIAL MEDICAL SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-997-0344
Mailing Address - Street 1:6819 SEPULVEDA BL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-6528
Mailing Address - Country:US
Mailing Address - Phone:818-997-0344
Mailing Address - Fax:818-997-0385
Practice Address - Street 1:6819 SEPULVEDA BL
Practice Address - Street 2:SUITE 101
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-6528
Practice Address - Country:US
Practice Address - Phone:818-997-0344
Practice Address - Fax:818-997-0385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002058308-0001-9332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5582860001Medicare NSC