Organization
BEDSIDE GTUBE REPLACEMENT AND MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN SANGMOAH PA (CEO/PRESIDENT)
(323) 200-4524
Entity
Organization
Contact information
Practice address
11429 BERENDO AVE, LOS ANGELES, CA 90044-1202
(323) 200-4524
Mailing address
11429 BERENDO AVE, LOS ANGELES, CA 90044-1202
(323) 200-4524
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
—
—
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/22/2018
Last updated
12/17/2022
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