Healthcare Provider Details

I. General information

NPI: 1730254244
Provider Name (Legal Business Name): CMA STATEWIDE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 79TH AVE SUITE 118
DORAL FL
33122-1073
US

IV. Provider business mailing address

2500 NW 79TH AVE SUITE 118
DORAL FL
33122-1073
US

V. Phone/Fax

Practice location:
  • Phone: 305-477-0222
  • Fax:
Mailing address:
  • Phone: 305-477-0222
  • 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: CARLOS V MONTEAGUDO
Title or Position: PRESIDENT
Credential:
Phone: 305-477-0222