| NPI | 1841616018 |
|---|---|
| Former Legal Business Name | LA MEDICAL STORE LLC |
| Entity Type | Organization |
| Authorized Contact | PAULINUS NDIBE CEO 626-639-3975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| 335G00000X Medical Foods Supplier | |
| 335V00000X Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2014-03-12 |