Healthcare Provider Details

I. General information

NPI: 1457577967
Provider Name (Legal Business Name): AVATAR MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E 4TH AVE
HIALEAH FL
33010-4907
US

IV. Provider business mailing address

211 E 4TH AVE
HIALEAH FL
33010-4907
US

V. Phone/Fax

Practice location:
  • Phone: 305-884-1915
  • Fax: 305-884-1913
Mailing address:
  • Phone: 305-884-1915
  • Fax: 305-884-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1313375
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number32 6579
License Number StateFL

VIII. Authorized Official

Name: SERGIO TOLEDO
Title or Position: PRESIDENT
Credential:
Phone: 305-884-1915