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General NPI Number Information
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NPI Number | 1235122508
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Entity Type | Organization
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Legal Business Name | PAND L DIVERSE SERVICE CORP
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2837 CORAL WAY
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City | CORAL GABLES
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State | FL
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Zip | 33145-3203
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Country | US
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Telephone | 305-443-8098
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Fax | 305-448-7586
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Provider Business Mailing Address
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Address Line | 2837 CORAL WAY
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City | CORAL GABLES
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State | FL
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Zip | 33145-3203
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Country | US
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Telephone | 305-443-8098
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Fax | 305-448-7586
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MIRIAM PATRICIA BARRETO
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Credential |
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Telephone | 305-443-8098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | FL
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