NPIMap

Organization Active NPI

Supercare Depot Inc

  • Durable Medical Equipment & Medical Supplies
  • Los Angeles, CA
National Provider Identifier
1598376790
Registry record updated Aug 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
SUPERCARE DEPOT INC
Doing business as
Supercare Depot Inc
Practice address
11901 Santa Monica Blvd Ste 470
Los Angeles, CA 90025-2767
Phone
(310) 422-1720
NPI assigned
Aug 11, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2020

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

Authorized official

Name
Mehran Michael Khalili
Title
Ceo
Phone
(310) 422-1720

Specialties & licenses 1

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

Addresses

Primary practice location

11901 Santa Monica Blvd Ste 470
Los Angeles, CA 90025-2767

Mailing address

11901 Santa Monica Blvd Ste 470
Los Angeles, CA 90025-2767
Phone (310) 422-1720

Other names 1

  • Supercare Depot Inc Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address info@supercaredepot.com Direct

National Provider Directory

National Provider Directory

Locations

11901 Santa Monica Blvd
Ste 470
Los Angeles, CA 90025
Phone (310) 422-1720

NPI Registry JSON

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

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597104000000",
    "number": "1598376790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11901 SANTA MONICA BLVD STE 470",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900252767",
            "telephone_number": "310-422-1720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11901 SANTA MONICA BLVD STE 470",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900252767",
            "telephone_number": "310-422-1720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERCARE DEPOT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-11",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A",
        "authorized_official_last_name": "KHALILI",
        "authorized_official_first_name": "MEHRAN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-422-1720"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@supercaredepot.com",
            "affiliation": "N",
            "endpointDescription": "info@supercaredepot.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11901 Santa Monica Blvd Ste 470",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900252767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Supercare Depot Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.