# PROVECTA MEDICAL SUPPLY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1992589873
- **Authorized official:** REZA JABARZADE (CEO)
- **Authorized official phone:** (424) 281-8834

## Contact information

- **Practice address:** 6333 WILSHIRE BLVD FL 1, LOS ANGELES, CA 90048-5702
- **Practice address phone:** (310) 861-3738
- **Mailing address:** 6333 WILSHIRE BLVD FL 1, LOS ANGELES, CA 90048-5702
- **Mailing address phone:** (310) 861-3738

## Taxonomy

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

## Other

- **Enumeration date:** 08/22/2023
- **Last updated:** 12/05/2023