1952311557 NPI number — THE DIABETIC & MOBILITY STORE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952311557 NPI number — THE DIABETIC & MOBILITY STORE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DIABETIC & MOBILITY STORE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952311557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3517
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLIDAY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34692-0517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-361-0103
Provider Business Mailing Address Fax Number:
727-937-7389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 111 KM 14.3
Provider Second Line Business Practice Location Address:
BO HATO ARRIBA #5
Provider Business Practice Location Address City Name:
SAN SEBASTIAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-280-0039
Provider Business Practice Location Address Fax Number:
787-280-0094
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-361-0103

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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