Provider Demographics
NPI:1376203505
Name:MAMA'S ON WHEELS LLC
Entity Type:Organization
Organization Name:MAMA'S ON WHEELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BORJA
Authorized Official - Middle Name:
Authorized Official - Last Name:FABREGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-395-8099
Mailing Address - Street 1:111 SW 3RD ST STE PH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1926
Mailing Address - Country:US
Mailing Address - Phone:305-395-8099
Mailing Address - Fax:
Practice Address - Street 1:111 SW 3RD ST STE PH
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1926
Practice Address - Country:US
Practice Address - Phone:305-395-8099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335G00000XSuppliersMedical Foods Supplier