Provider Demographics
NPI:1285443713
Name:ICEBERG MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:ICEBERG MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOMAN
Authorized Official - Middle Name:QASIM
Authorized Official - Last Name:BROHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-735-8065
Mailing Address - Street 1:8475 ARTESIA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-8424
Mailing Address - Country:US
Mailing Address - Phone:714-735-8065
Mailing Address - Fax:
Practice Address - Street 1:8475 ARTESIA BLVD STE A
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-8424
Practice Address - Country:US
Practice Address - Phone:714-735-8065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies