Healthcare Provider Details

I. General information

NPI: 1003860933
Provider Name (Legal Business Name): LIZMAR OF SOUTH FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9676 NW 25TH ST
DORAL FL
33172-1403
US

IV. Provider business mailing address

9676 NW 25TH ST
DORAL FL
33172-1403
US

V. Phone/Fax

Practice location:
  • Phone: 305-436-9460
  • Fax: 305-436-9462
Mailing address:
  • Phone: 305-436-9460
  • Fax: 305-436-9462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH22942
License Number StateFL

VIII. Authorized Official

Name: ESTELA CABRERA
Title or Position: PRESIDENT
Credential:
Phone: 305-436-9460