MEDICARE: 2ND PHOENIX INC

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	7178621	FL

General Provider Information

NPI Number	:	1508301904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2ND PHOENIX INC

Provider Business Mailing Address
First Line	:	7420 W 18TH LN
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-3717
Country	:	US
Telephone Number	:	305-600-4421
Fax Number	:	786-475-1414

Provider Business Practice Location Address
First Line	:	7420 W 18TH LN
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-3717
Country	:	US
Telephone Number	:	305-600-4421
Fax Number	:	786-475-1414

Authorized Official
Title or Position	:	CEO
Name	:	MR. SERGIO BECERRA SR.
Credential	:
Telephone Number	:	305-600-4421

Provider Enumeration Date	:	12/21/2016
Last Update Date	:	12/21/2016

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