Healthcare Provider Details

I. General information

NPI: 1437988854
Provider Name (Legal Business Name): DC MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 VISTA PKWY STE 400
WEST PALM BEACH FL
33411-6742
US

IV. Provider business mailing address

824 SANTA HELENA AVE
HENDERSON NV
89002-9016
US

V. Phone/Fax

Practice location:
  • Phone: 702-528-4544
  • Fax: 916-415-2925
Mailing address:
  • Phone: 702-480-5617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DAILIN CARMENATE RIVAS
Title or Position: CEO/MANAGER
Credential:
Phone: 702-480-5617