MEDICARE: PANDA KITCHEN CABINETS AND VANITIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	07000396	FL

General Provider Information

NPI Number	:	1104179761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANDA KITCHEN CABINETS AND VANITIES

Provider Business Mailing Address
First Line	:	6412 PEMBROKE RD
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-2138
Country	:	US
Telephone Number	:	954-322-9089
Fax Number	:	954-322-9088

Provider Business Practice Location Address
First Line	:	6412 PEMBROKE RD
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-2138
Country	:	US
Telephone Number	:	954-322-9089
Fax Number	:	954-322-9088

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. DAVID ISMAEL ARIAS
Credential	:
Telephone Number	:	954-322-9089

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	10/19/2012

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