Provider Demographics
NPI:1881726990
Name:MAYDADS MEDICAL SUPPLY
Entity type:Organization
Organization Name:MAYDADS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SYLVESTER
Authorized Official - Middle Name:O
Authorized Official - Last Name:IJEWERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-221-6900
Mailing Address - Street 1:8939 WOODMAN AVE
Mailing Address - Street 2:STE 9
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-8015
Mailing Address - Country:US
Mailing Address - Phone:818-221-6900
Mailing Address - Fax:818-221-6944
Practice Address - Street 1:8939 WOODMAN AVE
Practice Address - Street 2:STE 9
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-8015
Practice Address - Country:US
Practice Address - Phone:818-221-6900
Practice Address - Fax:818-221-6944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46889332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6093840001Medicare NSC