Healthcare Provider Details

I. General information

NPI: 1912904160
Provider Name (Legal Business Name): YOUNG ORTHOPEDICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 E 4TH AVE
HIALEAH FL
33010-3502
US

IV. Provider business mailing address

1204 E 4TH AVE
HIALEAH FL
33010-3502
US

V. Phone/Fax

Practice location:
  • Phone: 305-888-7996
  • Fax: 305-888-7763
Mailing address:
  • Phone: 305-888-7996
  • Fax: 305-888-7763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1086
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number32 03576
License Number StateFL

VIII. Authorized Official

Name: LISBETT HIDALGO
Title or Position: PRESIDENT
Credential:
Phone: 305-888-7996