Organization
LAKE AVENUE MEDICAL SUPPLY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RONEN SARAFIAN MALEK (PRESIDENT)
(626) 405-0440
Entity
Organization
Contact information
Practice address
467 N LAKE AVE, PASADENA, CA 91101-1215
(626) 405-0440
(626) 405-0450
Mailing address
467 N LAKE AVE, PASADENA, CA 91101-1215
(626) 405-0440
(626) 405-0450
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
53974
CA
Other
Enumeration date
11/15/2010
Last updated
11/15/2010
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