Healthcare Provider Details

I. General information

NPI: 1346304862
Provider Name (Legal Business Name): FMA FIRST MEDICAL ASSURANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4847 SW 75TH AVE
MIAMI FL
33155-4438
US

IV. Provider business mailing address

4847 SW 75TH AVE
MIAMI FL
33155-4438
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-7340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RAQUEL M DATESH
Title or Position: PRESIDENT
Credential:
Phone: 305-262-7340