Provider Demographics
NPI:1063425668
Name:VILA MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:VILA MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOKAREV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-437-9434
Mailing Address - Street 1:PO BOX 56334
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-1334
Mailing Address - Country:US
Mailing Address - Phone:818-785-7722
Mailing Address - Fax:818-785-7772
Practice Address - Street 1:14545 FRIAR ST
Practice Address - Street 2:SUITE 112
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2357
Practice Address - Country:US
Practice Address - Phone:818-785-7722
Practice Address - Fax:818-785-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies