Healthcare Provider Details

I. General information

NPI: 1740196211
Provider Name (Legal Business Name): ALTA MOROCHA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 METROPOLITAN OVAL SUITE 4F
BRONX NY
10462
US

IV. Provider business mailing address

40 METROPOLITAN OVAL SUITE 4F
BRONX NY
10462
US

V. Phone/Fax

Practice location:
  • Phone: 646-724-7399
  • Fax:
Mailing address:
  • Phone: 646-724-7399
  • 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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: KAYRA MARTINEZ
Title or Position: MANAGING MEMBER
Credential:
Phone: 646-724-7399