Provider Demographics
NPI:1871572198
Name:LUTEMI MEDICAL SUPPLY
Entity type:Organization
Organization Name:LUTEMI MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OLUFUNKE
Authorized Official - Middle Name:IBIYEMI
Authorized Official - Last Name:FADOJUTIMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-324-9265
Mailing Address - Street 1:550 E CARSON PLAZA DR
Mailing Address - Street 2:SUITE #125
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3229
Mailing Address - Country:US
Mailing Address - Phone:310-324-9265
Mailing Address - Fax:
Practice Address - Street 1:550 E CARSON PLAZA DR
Practice Address - Street 2:SUITE #125
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3229
Practice Address - Country:US
Practice Address - Phone:310-324-9265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103363332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2695436Medicaid
CA2695436Medicaid