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General NPI Number Information
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NPI Number | 1417365859
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Entity Type | Organization
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Legal Business Name | MILLIONAIRE FRESH INC
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 98 VANDERFORD RD E
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City | ORANGE PARK
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State | FL
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Zip | 32073-5919
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Country | US
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Telephone | 904-589-0351
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Fax |
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Provider Business Mailing Address
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Address Line | 15515 S VERMONT AVE 5
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City | GARDENA
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State | CA
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Zip | 90247-4156
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Country | US
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Telephone | 323-220-8672
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. RODERICK JOHNSON
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Credential |
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Telephone | 323-220-8672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State | CA
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