Provider Demographics
NPI:1427079383
Name:DOMTEK MEDICAL&ALLIED SERVICES INC
Entity type:Organization
Organization Name:DOMTEK MEDICAL&ALLIED SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATSON
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-242-7523
Mailing Address - Street 1:2930 W IMPERIAL HWY STE 200I
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-3142
Mailing Address - Country:US
Mailing Address - Phone:323-242-7523
Mailing Address - Fax:323-242-7523
Practice Address - Street 1:2930 W IMPERIAL HWY STE 200I
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-3142
Practice Address - Country:US
Practice Address - Phone:323-242-7523
Practice Address - Fax:323-242-7523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103058332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103058OtherHOME MEDICAL DEVICE RETAI
CA4865160001Medicare NSC