Healthcare Provider Details

I. General information

NPI: 1750330957
Provider Name (Legal Business Name): INTERMED EQUIPMENT SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6595 NW 36TH ST STE 224
VIRGINIA GARDENS FL
33166-6979
US

IV. Provider business mailing address

6595 NW 36TH ST STE 224
VIRGINIA GARDENS FL
33166-6979
US

V. Phone/Fax

Practice location:
  • Phone: 305-871-4644
  • Fax: 305-825-3810
Mailing address:
  • Phone: 305-871-4644
  • Fax: 305-825-3810

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: YESENIA PUELLO
Title or Position: PRESIDENT
Credential:
Phone: 305-871-4644