MEDICARE: EL MAMEY FRUTERIA 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	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1356125066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL MAMEY FRUTERIA CORP

Provider Business Mailing Address
First Line	:	4410 WEST 16TH AVE UNIT #10
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7101
Country	:	US
Telephone Number	:	786-263-1763
Fax Number	:

Provider Business Practice Location Address
First Line	:	EL MAMEY FRUTERIA CORP
Second Line	:	4410 WEST 16TH AVE UNIT #10
City	:	HIALEAH
State	:	FL
Zip	:	33012-7101
Country	:	US
Telephone Number	:	786-263-1763
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RODOLFO ALVAREZ
Credential	:
Telephone Number	:	786-263-1763

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	08/23/2023

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Directions to “EL MAMEY FRUTERIA CORP ” Practice Location

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