Healthcare Provider Details

I. General information

NPI: 1326326737
Provider Name (Legal Business Name): DIABETIC ASSISTANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 SW 52ND AVE
PEMBROKE PARK FL
33023-2380
US

IV. Provider business mailing address

3215 SW 52ND AVE UNIT 47
PEMBROKE PARK FL
33023-2380
US

V. Phone/Fax

Practice location:
  • Phone: 954-639-3125
  • Fax:
Mailing address:
  • Phone: 954-639-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. DOUGLAS BRANDON GRANGER
Title or Position: OWNER
Credential:
Phone: 954-639-3125