Healthcare Provider Details

I. General information

NPI: 1083416945
Provider Name (Legal Business Name): MEDIVANCE DME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 NW 112TH AVE UNIT 1
DORAL FL
33172-1867
US

IV. Provider business mailing address

2900 NW 112TH AVE UNIT 1
DORAL FL
33172-1867
US

V. Phone/Fax

Practice location:
  • Phone: 786-359-4262
  • Fax:
Mailing address:
  • Phone: 786-359-4262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ILIANA FESTARY
Title or Position: OWNER
Credential:
Phone: 786-359-4262