Provider Demographics
NPI:1215017967
Name:ALBA MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ALBA MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-644-0177
Mailing Address - Street 1:1901 NW 17TH ST
Mailing Address - Street 2:105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1403
Mailing Address - Country:US
Mailing Address - Phone:305-644-0177
Mailing Address - Fax:305-644-0178
Practice Address - Street 1:1901 NW 17TH ST
Practice Address - Street 2:105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1403
Practice Address - Country:US
Practice Address - Phone:305-644-0177
Practice Address - Fax:305-644-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN