1861465734 NPI number — EWEZCO MEDICAL SUPPLY

Table of content: MS. SUSAN M. MULLEN LCSW, CADC (NPI 1265680508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861465734 NPI number — EWEZCO MEDICAL SUPPLY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EWEZCO MEDICAL SUPPLY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861465734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 E CARSON PLAZA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90746-3220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-965-0230
Provider Business Mailing Address Fax Number:
310-965-0263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 E CARSON PLAZA CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARSON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90746-3289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-965-0230
Provider Business Practice Location Address Fax Number:
310-965-0263
Provider Enumeration Date:
02/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OKPAN
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
OGBU
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
323-702-2264

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)