MEDICARE: UNIVERSITY 65 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

General Provider Information

NPI Number	:	1497515266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY 65 CORP

Provider Business Mailing Address
First Line	:	9690 W SAMPLE RD STE 203
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4053
Country	:	US
Telephone Number	:	754-812-1087
Fax Number	:

Provider Business Practice Location Address
First Line	:	9690 W SAMPLE RD STE 203
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4053
Country	:	US
Telephone Number	:	754-812-1087
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	LIVAN CACERES
Credential	:
Telephone Number	:	754-812-1087

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	03/20/2024

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