Healthcare Provider Details

I. General information

NPI: 1326045345
Provider Name (Legal Business Name): THE MEDICARE SHOPPE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 E 4TH AVE
HIALEAH FL
33013-3210
US

IV. Provider business mailing address

3013 E 4TH AVE
HIALEAH FL
33013-3210
US

V. Phone/Fax

Practice location:
  • Phone: 305-693-3544
  • Fax: 305-693-3519
Mailing address:
  • Phone: 305-693-3544
  • Fax: 305-693-3519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1222810001
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH16014
License Number StateFL

VIII. Authorized Official

Name: MR. LUIS ANDRES FERNANDEZ
Title or Position: PRESIDENT / PROGRAM DIRECTOR
Credential: CERTIFIED ORTHOTIST
Phone: 305-693-3544