Healthcare Provider Details

I. General information

NPI: 1841261724
Provider Name (Legal Business Name): SAGUA MEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 NW 36 ST # 311
VIRGINIA GARDENS FL
33166-6975
US

IV. Provider business mailing address

6555 NW 36 ST # 311
VIRGINIA GARDENS FL
33166-6975
US

V. Phone/Fax

Practice location:
  • Phone: 305-870-0611
  • Fax: 305-870-0612
Mailing address:
  • Phone: 305-870-0611
  • Fax: 305-870-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number3130
License Number StateFL

VIII. Authorized Official

Name: MS. MARIA PEREZ
Title or Position: PRESIDENT
Credential:
Phone: 305-870-0611