Provider Demographics
NPI:1275529265
Name:MARIO & CLARA MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:MARIO & CLARA MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-644-4090
Mailing Address - Street 1:201 SW 22ND AVE
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1545
Mailing Address - Country:US
Mailing Address - Phone:305-644-4090
Mailing Address - Fax:305-541-3719
Practice Address - Street 1:201 SW 22ND AVE
Practice Address - Street 2:SUITE # 2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1545
Practice Address - Country:US
Practice Address - Phone:305-644-4090
Practice Address - Fax:305-541-3719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5417080001Medicare ID - Type UnspecifiedPROVIDER NUMBER