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General NPI Number Information
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NPI Number | 1508992777
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED SPECIALTIES
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Dates
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Enumeration Date | 02/24/2007
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 8000 RON BEATTY BLVD SUITE A-3
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City | MICCO
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State | FL
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Zip | 32976-7474
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Country | US
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Telephone | 772-664-3668
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Fax | 772-664-3343
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Provider Business Mailing Address
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Address Line | 8000 RON BEATTY BLVD SUITE A-3
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City | MICCO
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State | FL
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Zip | 32976-7474
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Country | US
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Telephone | 772-664-3668
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Fax | 772-664-3343
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE MARTIN NIGRO
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Credential | D.P.M.
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Telephone | 772-664-3668
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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 |
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