Healthcare Provider Details

I. General information

NPI: 1942960208
Provider Name (Legal Business Name): ICELAND MEDICAL EQUIPMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 NW 72ND AVE STE 112
MIAMI FL
33126-3009
US

IV. Provider business mailing address

772 NW 72 AVE SUITE 1127
MIAMI FL
33126
US

V. Phone/Fax

Practice location:
  • Phone: 786-360-2060
  • Fax:
Mailing address:
  • Phone: 305-413-6356
  • 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: DAGOBERTO GOMEZ AGUILA
Title or Position: OWNER
Credential:
Phone: 305-413-6356