MEDICARE: MAYPOR MEDICAL SUPPLIES

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1164475786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYPOR MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	7321 W FLAGLER ST
Second Line	:	SUITE B
City	:	MIAMI
State	:	FL
Zip	:	33144-2505
Country	:	US
Telephone Number	:	305-265-5001
Fax Number	:

Provider Business Practice Location Address
First Line	:	7321 W FLAGLER ST
Second Line	:	SUITE B
City	:	MIAMI
State	:	FL
Zip	:	33144-2505
Country	:	US
Telephone Number	:	305-265-5001
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAYRA FAJARDO
Credential	:
Telephone Number	:	305-265-5001

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/22/2020

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