Provider Demographics
NPI:1235691007
Name:NEWAVE MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:NEWAVE MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-397-1576
Mailing Address - Street 1:331 W CENTRAL AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-2984
Mailing Address - Country:US
Mailing Address - Phone:863-292-6097
Mailing Address - Fax:
Practice Address - Street 1:331 W CENTRAL AVE STE 225
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2984
Practice Address - Country:US
Practice Address - Phone:863-292-6097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies