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General NPI Number Information
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NPI Number | 1700967072
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Entity Type | Organization
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Legal Business Name | FRESNILLO SUPPLIES INC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4290 10TH AVE N UNIT 104
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City | LAKE WORTH
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State | FL
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Zip | 33461-2304
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Country | US
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Telephone | 561-964-7474
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Fax | 561-964-7878
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Provider Business Mailing Address
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Address Line | 4290 10TH AVE N UNIT 104
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City | LAKE WORTH
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State | FL
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Zip | 33461-2304
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Country | US
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Telephone | 561-964-7474
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Fax | 561-964-7878
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSE FRESNILLO
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Credential |
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Telephone | 561-964-7474
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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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