MEDICARE: ANGELINA HEALTH CARE, 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	1097	FL

General Provider Information

NPI Number	:	1669414256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELINA HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	687 E 9TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4523
Country	:	US
Telephone Number	:	305-863-8473
Fax Number	:

Provider Business Practice Location Address
First Line	:	687 E 9TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4523
Country	:	US
Telephone Number	:	305-863-8473
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GUILLERMO GARCIA
Credential	:
Telephone Number	:	305-863-8473

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	08/22/2020

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