MEDICARE: FRESNILLO SUPPLIES 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

General Provider Information

NPI Number	:	1700967072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESNILLO SUPPLIES INC

Provider Business Mailing Address
First Line	:	4290 10TH AVE N
Second Line	:	UNIT 104
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-2304
Country	:	US
Telephone Number	:	561-964-7474
Fax Number	:	561-964-7878

Provider Business Practice Location Address
First Line	:	4290 10TH AVE N
Second Line	:	UNIT 104
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-2304
Country	:	US
Telephone Number	:	561-964-7474
Fax Number	:	561-964-7878

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSE FRESNILLO
Credential	:
Telephone Number	:	561-964-7474

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/22/2020

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