Organization
BETHANY MEDICAL SUPPLY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HIBEST ESSAYAS (CEO PRESIDENT)
(626) 961-8699
Entity
Organization
Contact information
Practice address
525 N AZUSA AVE STE 111, LA PUENTE, CA 91744-4261
(626) 961-8699
(626) 961-8806
Mailing address
525 N AZUSA AVE STE 111, LA PUENTE, CA 91744-4261
(626) 961-8699
(626) 961-8806
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
332B00000X
CA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
103509
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0199939
—
CA
01
—
DME03250F
CROSS OVER MEDICAL
CA
Enumeration date
06/29/2006
Last updated
08/09/2012
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