Organization
ANGELES VISTA MEDICAL SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARKSON BOLA ALABI CO (SOLE-PROPRIETOR)
(562) 699-7200
Entity
Organization
Contact information
Practice address
11929 LOS NIETOS ROAD, SANTA FE SPRINGS, CA 90670-2527
(562) 699-7200
(562) 699-7210
Mailing address
11929 LOS NIETOS ROAD, SANTA FE SPRINGS, CA 90670-2527
(562) 699-7200
(562) 699-7210
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
DME02177F
CA
332BC3200X
Customized Equipment (DME)
DME02177F
CA
332BX2000X
Oxygen Equipment & Supplies (DME)
DME02177F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DME02177F
—
CA
Enumeration date
10/03/2006
Last updated
08/31/2007
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