Organization
OVIK AVETISYAN
Active
Other names
AEG Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OVIK AVETISYAN (OWNER)
(323) 666-9410
Entity
Organization
Contact information
Practice address
5068 HOLLYWOOD BLVD, LOS ANGELES, CA 90027-6110
(323) 666-9410
(323) 666-9462
Mailing address
5068 HOLLYWOOD BLVD, LOS ANGELES, CA 90027-6110
(323) 666-9410
(323) 666-9462
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101092
HMDR
CA
05
—
1260050001
—
CA
01
—
130157
BUREAU OF HOME FURNISHER
CA
01
—
DME02547F
MEDICAL
—
Enumeration date
07/19/2006
Last updated
06/18/2008
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