Organization Active NPI

Prohealth Medical Supply Inc

  • Durable Medical Equipment & Medical Supplies
  • Los Angeles, CA
National Provider Identifier
1104123652
Registry record updated Aug 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
54295 Issued in CA
Legal business name
PROHEALTH MEDICAL SUPPLY INC
Practice address
4509 Eagle Rock Blvd
Ste B
Los Angeles, CA 90041-3214
Phone
(323) 255-3504
Fax
(323) 255-3504
NPI assigned
Feb 18, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Abdul R Wahab
Title
Ceo
Phone
(510) 329-7997

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 54295 CA Primary

Addresses

Primary practice location

4509 Eagle Rock Blvd
Ste B
Los Angeles, CA 90041-3214

Mailing address

4625 First St
Suite B
Pleasanton, CA 94566
Phone (510) 329-7997

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Prohealth Medical Supply Inc.4509 Eagle Rock Blvd, Los Angeles, CA 90041-3214(323) 255-3504 Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Hospital Beds (Electric)|Hospital Beds (Manual)|Support Surfaces: Pressure Reducing Beds/Mats/Pads|Traction Equipment|(TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies|Canes and/or … Does not accept assignmentParticipating since Apr 22, 2011

National Provider Directory

National Provider Directory

Locations

4509 Eagle Rock Blvd
#B
Los Angeles, CA 90041
Phone (323) 255-3504

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787961600000",
    "number": "1104123652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4625 FIRST ST",
            "address_2": "SUITE B",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "94566",
            "telephone_number": "510-329-7997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4509 EAGLE ROCK BLVD",
            "address_2": "STE B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900413214",
            "telephone_number": "323-255-3504",
            "fax_number": "323-255-3504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH MEDICAL SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-18",
        "last_updated": "2026-08-29",
        "certification_date": "2026-08-29",
        "status": "A",
        "authorized_official_last_name": "WAHAB",
        "authorized_official_first_name": "ABDUL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-329-7997",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "54295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.