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Organization

ESSENTIAL MEDICAL SUPPLIES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BENNIE OBIAGELI NIBO (PRESIDENT)
(310) 679-5025
Entity
Organization

Contact information

Practice address
12852 HAWTHORNE BLVD, HAWTHORNE, CA 90250-4407
(310) 679-5025
(310) 679-5095
Mailing address
12852 HAWTHORNE BLVD, HAWTHORNE, CA 90250-4407
(310) 679-5025
(310) 679-5095

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
103582
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
DME03343F
CA
Enumeration date
07/17/2006
Last updated
01/14/2008
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