Provider Demographics
NPI:1124266093
Name:LEGEND MEDICAL EQUIPMENT & SUPPLIES, INC
Entity type:Organization
Organization Name:LEGEND MEDICAL EQUIPMENT & SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDULMALIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-329-3272
Mailing Address - Street 1:17725 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4138
Mailing Address - Country:US
Mailing Address - Phone:310-329-3272
Mailing Address - Fax:877-546-0005
Practice Address - Street 1:17725 CRENSHAW BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-4138
Practice Address - Country:US
Practice Address - Phone:310-329-3272
Practice Address - Fax:877-546-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50709332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6251350001Medicare NSC