Healthcare Provider Details

I. General information

NPI: 1437522166
Provider Name (Legal Business Name): MIAMI MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 NW 42ND AVE 408
MIAMI FL
33126-5683
US

IV. Provider business mailing address

351 NW 42ND AVE 408
MIAMI FL
33126-5683
US

V. Phone/Fax

Practice location:
  • Phone: 305-631-5355
  • Fax: 305-631-5354
Mailing address:
  • Phone: 305-631-5355
  • Fax: 305-631-5354

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: ERIC VALLADARES
Title or Position: CEO
Credential:
Phone: 305-631-5355