Provider Demographics
NPI:1982761201
Name:PRIMO MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:PRIMO MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHNASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-232-1465
Mailing Address - Street 1:17337 VENTURA BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3903
Mailing Address - Country:US
Mailing Address - Phone:818-909-3790
Mailing Address - Fax:818-768-7711
Practice Address - Street 1:17337 VENTURA BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3903
Practice Address - Country:US
Practice Address - Phone:818-909-3790
Practice Address - Fax:818-768-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5988790001Medicare NSC