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General NPI Number Information
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NPI Number | 1881056836
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Entity Type | Organization
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Legal Business Name | DIABETIC SHOE SOURCE INC.
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 156 S CHARLES RICHARD BEALL BLVD SUITE 3
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City | DEBARY
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State | FL
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Zip | 32713-3273
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Country | US
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Telephone | 407-323-5093
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Fax | 407-386-8074
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Provider Business Mailing Address
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Address Line | 156 S CHARLES RICHARD BEALL BLVD SUITE 3
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City | DEBARY
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State | FL
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Zip | 32713-3273
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Country | US
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Telephone | 407-323-5093
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Fax | 407-386-8074
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY H RIVERA
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Credential | C. PED
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Telephone | 407-323-5093
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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 | NOT REQUIRED
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License Number State | FL
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