=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619904653
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONCHA GENERAL SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1799 NE 164TH ST SUITE 112
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33162-4008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-787-6060
-----------------------------------------------------
Fax | 305-787-0999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1799 NE 164TH ST SUITE 112
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33162-4008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-787-6060
-----------------------------------------------------
Fax | 305-787-0999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | ALAIN LEON RICARDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-787-6060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------