# GUSTINO MEDICAL SUPPLY CO.

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

## Provider details

- **NPI number:** 1598756900
- **Authorized official:** MR. AUGUSTINE OKON UWAH (OWNER)
- **Authorized official phone:** (310) 523-2123

## Contact information

- **Practice address:** 13998 CRENSHAW BLVD, GARDENA, CA 90249-2714
- **Practice address phone:** (310) 523-2123
- **Practice address fax:** (310) 523-2192
- **Mailing address:** 13998 CRENSHAW BLVD, P.O. BOX 1588, GARDENA, CA 90249-2714
- **Mailing address phone:** (310) 523-2123
- **Mailing address fax:** (310) 523-2192

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 102504 | CA | Yes |

## Other

- **Enumeration date:** 11/03/2005
- **Last updated:** 08/12/2008