Healthcare Provider Details

I. General information

NPI: 1609006667
Provider Name (Legal Business Name): MANUEL Y PAULINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 TOWNSEND BLVD # 305
JACKSONVILLE FL
32277-9303
US

IV. Provider business mailing address

3501 TOWNSEND BLVD # 305
JACKSONVILLE FL
32277-9303
US

V. Phone/Fax

Practice location:
  • Phone: 305-202-4751
  • Fax:
Mailing address:
  • Phone: 305-202-4751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERTO DIAZ
Title or Position: PRESIDENT
Credential:
Phone: 305-202-4751