Provider Demographics
NPI:1114549011
Name:DE LOS ANGELES DME, LLC
Entity Type:Organization
Organization Name:DE LOS ANGELES DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-616-3544
Mailing Address - Street 1:1409 S 9TH AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5527
Mailing Address - Country:US
Mailing Address - Phone:956-616-3544
Mailing Address - Fax:
Practice Address - Street 1:1409 S 9TH AVE STE 311
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5527
Practice Address - Country:US
Practice Address - Phone:956-616-3544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies