Provider Demographics
NPI:1538376298
Name:LAX HEALTH CARE TECHNOLGY
Entity type:Organization
Organization Name:LAX HEALTH CARE TECHNOLGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:OGWONUWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-738-0387
Mailing Address - Street 1:8939 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 424
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3631
Mailing Address - Country:US
Mailing Address - Phone:310-410-9907
Mailing Address - Fax:310-410-9387
Practice Address - Street 1:8939 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 424
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3631
Practice Address - Country:US
Practice Address - Phone:310-410-9907
Practice Address - Fax:310-410-9387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46844332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4670910003Medicare NSC