MEDICARE: LIFESTYLE MED SUPPLY LLC

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	:	1366011223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLE MED SUPPLY LLC

Provider Business Mailing Address
First Line	:	1275 W 49TH PL STE 423
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3139
Country	:	US
Telephone Number	:	786-334-6187
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 W 49TH PL STE 423
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3139
Country	:	US
Telephone Number	:	786-334-6187
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	NESTOR RODRIGUEZ
Credential	:
Telephone Number	:	305-898-9756

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	06/23/2021

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Directions to “LIFESTYLE MED SUPPLY LLC ” Practice Location

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