Provider Demographics
NPI:1508106683
Name:AMERICAN DIABETIC PLUS, INC
Entity Type:Organization
Organization Name:AMERICAN DIABETIC PLUS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-323-5093
Mailing Address - Street 1:4025 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9721
Mailing Address - Country:US
Mailing Address - Phone:321-363-3997
Mailing Address - Fax:321-363-3266
Practice Address - Street 1:4025 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9721
Practice Address - Country:US
Practice Address - Phone:321-363-3997
Practice Address - Fax:321-363-3266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies