Healthcare Provider Details

I. General information

NPI: 1659619435
Provider Name (Legal Business Name): VANGUARD MEDICAL EQUIPMENT, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 W 47TH PL STE 437
HIALEAH FL
33012-3454
US

IV. Provider business mailing address

1275 W 47TH PL STE 437
HIALEAH FL
33012-3454
US

V. Phone/Fax

Practice location:
  • Phone: 305-231-8227
  • Fax: 786-522-9050
Mailing address:
  • Phone: 305-231-8227
  • Fax: 786-522-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1313788
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number326883
License Number StateFL

VIII. Authorized Official

Name: MR. CARLOS LOPEZ
Title or Position: CEO
Credential: CRTT
Phone: 305-231-8227