| NPI | 1083304604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY E DEVINE Manager 323-459-3047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 171WV0202X Contractor, Vehicle Modifications |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2023-11-20 |