Healthcare Provider Details

I. General information

NPI: 1225068026
Provider Name (Legal Business Name): DOLPHIN SUPPLIES MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SW 8 ST SUITE 204
MIAMI FL
33130
US

IV. Provider business mailing address

1101 SW 8 ST SUITE 204
MIAMI FL
33130
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-2124
  • Fax: 305-854-2125
Mailing address:
  • Phone: 305-854-2124
  • Fax: 305-854-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1312463
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number3204093
License Number StateFL

VIII. Authorized Official

Name: MS. NORKA GUSHIKEN
Title or Position: PRESIDENT
Credential:
Phone: 305-854-2124