Healthcare Provider Details

I. General information

NPI: 1891454443
Provider Name (Legal Business Name): YIPJ SUPPLY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 NW 72ND AVE STE 3065
MIAMI FL
33126-3080
US

IV. Provider business mailing address

777 NW 72ND AVE STE 3065
MIAMI FL
33126-3080
US

V. Phone/Fax

Practice location:
  • Phone: 786-675-7313
  • Fax:
Mailing address:
  • Phone: 786-675-7313
  • 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: YOEL IDALBERTO PUENTES JUSTIZ
Title or Position: PRESIDENT
Credential:
Phone: 786-675-7313