Healthcare Provider Details

I. General information

NPI: 1538118518
Provider Name (Legal Business Name): TABRAUE ORTHOPEDIC MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 SW 16TH AVE
MIAMI FL
33135-2116
US

IV. Provider business mailing address

106 SW 16TH AVE
MIAMI FL
33135-2116
US

V. Phone/Fax

Practice location:
  • Phone: 305-649-4460
  • Fax: 305-649-9249
Mailing address:
  • Phone: 305-649-4460
  • Fax: 305-649-9249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberORF189
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RAUL TABRAUE
Title or Position: PRESIDENT
Credential:
Phone: 305-649-4460