Healthcare Provider Details

I. General information

NPI: 1639134737
Provider Name (Legal Business Name): MIAMI SUNSHINE MEDICAL SUPPLY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 W FLAGLER ST
MIAMI FL
33135-1939
US

IV. Provider business mailing address

1881 W FLAGLER ST
MIAMI FL
33135-1939
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-8505
  • Fax: 305-642-8505
Mailing address:
  • Phone: 305-642-8505
  • Fax: 305-642-8505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JAVIER DE LA CRUZ
Title or Position: PRESIDENT
Credential:
Phone: 305-642-8505