Healthcare Provider Details

I. General information

NPI: 1477589968
Provider Name (Legal Business Name): CORPUS CHRISTI MEDICAL SUPPLIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SW 17TH AVE SUITE 310
MIAMI FL
33135-3689
US

IV. Provider business mailing address

215 SW 17TH AVE SUITE 310
MIAMI FL
33135-3689
US

V. Phone/Fax

Practice location:
  • Phone: 305-649-8271
  • Fax: 305-649-6988
Mailing address:
  • Phone: 305-649-8271
  • Fax: 305-649-6988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1312083
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number3203663
License Number StateFL

VIII. Authorized Official

Name: MARINA NIEVES
Title or Position: PRESIDENT
Credential:
Phone: 305-649-8271