Provider Demographics
NPI:1538346218
Name:GLENDALE MEDICAL GEAR
Entity type:Organization
Organization Name:GLENDALE MEDICAL GEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARUTUNYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-242-5554
Mailing Address - Street 1:1422 S GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3378
Mailing Address - Country:US
Mailing Address - Phone:818-242-5554
Mailing Address - Fax:818-242-5553
Practice Address - Street 1:1422 S GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3378
Practice Address - Country:US
Practice Address - Phone:818-242-5554
Practice Address - Fax:818-242-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48977332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6083440001Medicare NSC