MEDICARE: DV INNOVATIONS 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER		NO OTHER PROVIDER INDENTIFIERS

General Provider Information

NPI Number	:	1619458882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DV INNOVATIONS LLC

Provider Business Mailing Address
First Line	:	152 FIG TREE RUN
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4067
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	152 FIG TREE RUN
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4067
Country	:	US
Telephone Number	:	407-516-8486
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE
Name	:	LUCAS DINGA
Credential	:
Telephone Number	:	727-403-5505

Provider Enumeration Date	:	08/27/2018
Last Update Date	:	08/27/2018

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Directions to “DV INNOVATIONS LLC ” Practice Location

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