Healthcare Provider Details

I. General information

NPI: 1013617133
Provider Name (Legal Business Name): ECB DLMALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7535 N KENDALL DR STE 3140
MIAMI FL
33156-8005
US

IV. Provider business mailing address

11390 SW 95TH ST
MIAMI FL
33176-1104
US

V. Phone/Fax

Practice location:
  • Phone: 939-644-4610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. MADELYNE CAJIGAS
Title or Position: PRESIDENT
Credential:
Phone: 939-644-4610