MEDICARE: PAND L DIVERSE SERVICE CORP

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		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	202341	OTHER	FL	ANERIGROUP

General Provider Information

NPI Number	:	1235122508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAND L DIVERSE SERVICE CORP

Provider Business Mailing Address
First Line	:	2837 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-3203
Country	:	US
Telephone Number	:	305-443-8098
Fax Number	:	305-448-7586

Provider Business Practice Location Address
First Line	:	2837 CORAL WAY
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-3203
Country	:	US
Telephone Number	:	305-443-8098
Fax Number	:	305-448-7586

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MIRIAM PATRICIA BARRETO
Credential	:
Telephone Number	:	305-443-8098

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/21/2022

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Directions to “PAND L DIVERSE SERVICE CORP ” Practice Location

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