Provider Demographics
NPI:1053522649
Name:SUN VALLEY MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:SUN VALLEY MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GURGEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TSATURYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-899-0150
Mailing Address - Street 1:12065 BRANFORD ST
Mailing Address - Street 2:UNIT 12
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-1006
Mailing Address - Country:US
Mailing Address - Phone:818-899-0150
Mailing Address - Fax:818-899-0194
Practice Address - Street 1:12065 BRANFORD ST
Practice Address - Street 2:UNIT 12
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-1006
Practice Address - Country:US
Practice Address - Phone:818-899-0150
Practice Address - Fax:818-899-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47206332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5905640001Medicare NSC