Healthcare Provider Details

I. General information

NPI: 1942919386
Provider Name (Legal Business Name): ECB DMALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 SW 136TH ST STE 140
MIAMI FL
33176-5870
US

IV. Provider business mailing address

385 CALLE SAN CLAUDIO
SAN JUAN PR
00926-4251
US

V. Phone/Fax

Practice location:
  • Phone: 787-672-4833
  • Fax:
Mailing address:
  • Phone: 787-672-4833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE ZAMBRANA
Title or Position: PRESIDENT
Credential:
Phone: 787-672-4833