# VITAL MEDICAL SUPPLY INC.

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

## Provider details

- **NPI number:** 1669601415
- **Authorized official:** MR. JOSE GAVIOLA (PRESIDENT)
- **Authorized official phone:** (323) 550-8888

## Contact information

- **Practice address:** 4515 EAGLE ROCK BLVD, SUITE 145C, LOS ANGELES, CA 90041-3214
- **Practice address phone:** (323) 550-8888
- **Practice address fax:** (323) 550-8881
- **Mailing address:** 4515 EAGLE ROCK BLVD., SUITE 145C, LOS ANGELES, CA 90041-3214
- **Mailing address phone:** (323) 550-8888
- **Mailing address fax:** (323) 550-8881

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 002197618 | CA | Yes |

## Other

- **Enumeration date:** 07/14/2009
- **Last updated:** 07/14/2009