Provider Demographics
NPI:1073069456
Name:VCA EQUIPMENTS & SUPPLIES, LLC
Entity Type:Organization
Organization Name:VCA EQUIPMENTS & SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NIOVES
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-854-8446
Mailing Address - Street 1:7925 NW 12TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1827
Mailing Address - Country:US
Mailing Address - Phone:305-854-8446
Mailing Address - Fax:305-859-7849
Practice Address - Street 1:7925 NW 12TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1827
Practice Address - Country:US
Practice Address - Phone:305-854-8446
Practice Address - Fax:305-859-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies