Organization
AVASCO MEDICAL SUPPLY INC.
Active
Other names
Avasco Medical Supply Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY ABABSEH (OWNER)
(805) 522-5333
Entity
Organization
Contact information
Practice address
690 EAST LOS ANGELES AVE., SUITE D, SIMI VALLEY, CA 93065-7503
(805) 522-5333
(805) 522-6333
Mailing address
690 EAST LOS ANGELES AVE., SUITE D, SIMI VALLEY, CA 93065-7503
(805) 522-5333
(805) 522-6333
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
396218-03
CA
332BX2000X
Oxygen Equipment & Supplies (DME)
100631
CA
335E00000X
Prosthetic/Orthotic Supplier
396218-03
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103377300
US DOL OWCP PROVIDER ID
CA
01
—
954360666
BLUE CROSS OF CALIFORNIA
CA
05
—
DME02516F
—
CA
Enumeration date
06/01/2005
Last updated
04/03/2012
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