Provider Demographics
NPI:1104932334
Name:JAMES O. EZE
Entity type:Organization
Organization Name:JAMES O. EZE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:O
Authorized Official - Last Name:EZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-750-1817
Mailing Address - Street 1:1704 W MANCHESTER AVE
Mailing Address - Street 2:SUITE 204C
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3034
Mailing Address - Country:US
Mailing Address - Phone:323-750-1817
Mailing Address - Fax:323-750-6872
Practice Address - Street 1:1704 W MANCHESTER AVE
Practice Address - Street 2:SUITE 204C
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3034
Practice Address - Country:US
Practice Address - Phone:323-750-1817
Practice Address - Fax:323-750-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102951332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03261FOtherCROSSOVER MEDICAL
CA4732930002Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT