Healthcare Provider Details

I. General information

NPI: 1760591754
Provider Name (Legal Business Name): MIB MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 NW 72 AVE # 203
MIAMI FL
33122
US

IV. Provider business mailing address

2550 NW 72 AVE # 203
MIAMI FL
33122
US

V. Phone/Fax

Practice location:
  • Phone: 305-629-6455
  • Fax: 305-629-6455
Mailing address:
  • Phone: 305-629-6455
  • Fax: 305-629-6455

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: MR. MARCOS VALDES JR.
Title or Position: OWNER
Credential:
Phone: 305-629-6455