Organization
PROMED MEDICAL SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN YADIDI (PRESIDENT)
(310) 836-6060
Entity
Organization
Contact information
Practice address
16200 VENTURA BLVD STE 101AB, ENCINO, CA 91436-2205
(310) 836-6060
(310) 836-9090
Mailing address
16661 VENTURA BLVD STE 518, ENCINO, CA 91436-1924
(310) 836-6060
(310) 836-9090
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6391860001
PTAN
CA
Enumeration date
07/22/2009
Last updated
02/10/2025
Update your record
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