=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861423063
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | E & L NUTRITION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10486 SW 72ND ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-275-0610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10486 SW 72ND ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-275-0610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ERNESTO GARCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-275-0610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 876
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------