Healthcare Provider Details

I. General information

NPI: 1184657116
Provider Name (Legal Business Name): MMA MEDICAL SUPPLIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 SW 137TH AVE SUITE 212
MIAMI FL
33175-8802
US

IV. Provider business mailing address

2450 SW 137TH AVE SUITE 212
MIAMI FL
33175-8802
US

V. Phone/Fax

Practice location:
  • Phone: 305-221-3232
  • Fax: 305-221-3536
Mailing address:
  • Phone: 305-221-3232
  • Fax: 305-221-3536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1294
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number32 02474
License Number StateFL

VIII. Authorized Official

Name: MS. AMARILYS RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-290-9908