1063477784 NPI number — LATIN MEDICAL SUPPLY 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 1063477784 NPI number — LATIN MEDICAL SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LATIN MEDICAL SUPPLY 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:
6
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:
1063477784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 E 1ST AVE
Provider Second Line Business Mailing Address:
STE 124
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33010-4963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-885-4214
Provider Business Mailing Address Fax Number:
305-885-4215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 E 1ST AVE
Provider Second Line Business Practice Location Address:
STE 124
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33010-4963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-885-4214
Provider Business Practice Location Address Fax Number:
305-885-4215
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BECEIRO
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-885-4214

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PH22896 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1029645 . This is a "NCPDP DME NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000925000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: PH22895 . This is a "PHARMACY LLICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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