Provider Demographics
NPI:1962738468
Name:MAXI-MED SUPPLES, INC
Entity type:Organization
Organization Name:MAXI-MED SUPPLES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALENUSH
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:AYVAZYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-578-8668
Mailing Address - Street 1:2315 KUEHNER DRIVE
Mailing Address - Street 2:SUITE #105
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3960
Mailing Address - Country:US
Mailing Address - Phone:805-978-8668
Mailing Address - Fax:
Practice Address - Street 1:2315 KUEHNER DRIVE
Practice Address - Street 2:#105
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3960
Practice Address - Country:US
Practice Address - Phone:805-578-8668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA196738468Medicaid
CA6707670001Medicare NSC