MEDICARE: DAILIS MEDEROS

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	183700000X	Pharmacy Technician	320101050756233	FL

General Provider Information

NPI Number	:	1659589943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAILIS MEDEROS

Provider Business Mailing Address
First Line	:	1481 W 41ST ST APT 316
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5942
Country	:	US
Telephone Number	:	305-801-9923
Fax Number	:

Provider Business Practice Location Address
First Line	:	5945 W 25TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-4423
Country	:	US
Telephone Number	:	305-558-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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Directions to “ DAILIS MEDEROS ” Practice Location

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