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General NPI Number Information
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NPI Number | 1710083381
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Entity Type | Organization
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Legal Business Name | MIRACLE MEDICAL EQUIPMENT & SUPPLIES, INC.
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/02/2009
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Provider Practice Location Address
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Address Line | 8075 SW 73RD AVE 8
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City | MIAMI
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State | FL
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Zip | 33143-7537
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Country | US
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Telephone | 786-291-2114
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Fax | 786-291-2114
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Provider Business Mailing Address
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Address Line | 8075 SW 73RD AVE 8
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City | MIAMI
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State | FL
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Zip | 33143-7537
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Country | US
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Telephone | 786-291-2114
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Fax | 786-291-2114
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Authorized Official
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Title or Position | OWNER/GM
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Name | OSVALDO RENE LASO
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Credential |
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Telephone | 786-291-2114
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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 | 1312481
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License Number State | FL
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