# ANGELES VISTA MEDICAL SUPPLIES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417041112
- **Authorized official:** MR. MARKSON BOLA ALABI CO (SOLE-PROPRIETOR)
- **Authorized official phone:** (562) 699-7200

## Contact information

- **Practice address:** 11929 LOS NIETOS ROAD, SANTA FE SPRINGS, CA 90670-2527
- **Practice address phone:** (562) 699-7200
- **Practice address fax:** (562) 699-7210
- **Mailing address:** 11929 LOS NIETOS ROAD, SANTA FE SPRINGS, CA 90670-2527
- **Mailing address phone:** (562) 699-7200
- **Mailing address fax:** (562) 699-7210

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | DME02177F | CA | Yes |
| 332BC3200X | Customized Equipment (DME) | DME02177F | CA | — |
| 332BX2000X | Oxygen Equipment & Supplies (DME) | DME02177F | CA | — |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 08/31/2007