Organization
VANTAGE MEDICAL SUPPLY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FABIAN MADUABUCHI OKWARAJI (DIRECTOR)
(310) 763-2234
Entity
Organization
Contact information
Practice address
427 N LONG BEACH BLVD, COMPTON, CA 90221-2218
(310) 763-2234
(310) 763-2058
Mailing address
427 N LONG BEACH BLVD, COMPTON, CA 90221-2218
(310) 763-2234
(310) 763-2058
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
103756
CA
332BC3200X
Customized Equipment (DME)
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8577638
—
CA
Enumeration date
05/11/2006
Last updated
07/09/2009
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