MEDICARE: EL ALMENDRON CUBAN CUISINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174200000X	Meals Provider	CAT2329604	FL

General Provider Information

NPI Number	:	1538646104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL ALMENDRON CUBAN CUISINE LLC

Provider Business Mailing Address
First Line	:	7281 SW 13TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-5305
Country	:	US
Telephone Number	:	305-978-0622
Fax Number	:	305-387-1555

Provider Business Practice Location Address
First Line	:	7281 SW 13TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-5305
Country	:	US
Telephone Number	:	305-978-0622
Fax Number	:	305-387-1555

Authorized Official
Title or Position	:	OWNER
Name	:	LEONEL MEDINA
Credential	:
Telephone Number	:	305-978-0622

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	07/25/2018

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