Provider Demographics
NPI:1144375023
Name:SYCAMORE MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:SYCAMORE MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRANIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-465-5654
Mailing Address - Street 1:7080 HOLLYWOOD BLVD
Mailing Address - Street 2:STE 920
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6906
Mailing Address - Country:US
Mailing Address - Phone:323-465-5654
Mailing Address - Fax:323-465-5398
Practice Address - Street 1:7080 HOLLYWOOD BLVD
Practice Address - Street 2:STE 920
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6906
Practice Address - Country:US
Practice Address - Phone:323-465-5654
Practice Address - Fax:323-465-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5574190001Medicare NSC