Healthcare Provider Details

I. General information

NPI: 1194286641
Provider Name (Legal Business Name): ECUAFAM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1569 BALTIMORE AVE
DELTONA FL
32725-5633
US

IV. Provider business mailing address

1569 BALTIMORE AVE
DELTONA FL
32725-5633
US

V. Phone/Fax

Practice location:
  • Phone: 386-215-7573
  • Fax:
Mailing address:
  • Phone: 386-215-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIEL CISNEROS
Title or Position: PRESIDENT
Credential:
Phone: 386-215-7573