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General NPI Number Information
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NPI Number | 1609892876
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Entity Type | Organization
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Legal Business Name | YJM MEGA MEDICAL SUPPLY, CORP
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15025 NW 77TH AVE SUITE 211
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6852
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Country | US
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Telephone | 305-828-5355
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Fax |
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Provider Business Mailing Address
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Address Line | 15025 NW 77TH AVE SUITE 211
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6852
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESUS MARTINEZ
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Credential |
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Telephone | 305-828-5355
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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 | 5849840
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License Number State | FL
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