Provider Demographics
NPI:1508301904
Name:2ND PHOENIX INC
Entity Type:Organization
Organization Name:2ND PHOENIX INC
Other - Org Name:SB MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BECERRA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:305-600-4421
Mailing Address - Street 1:7420 W 18TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3717
Mailing Address - Country:US
Mailing Address - Phone:305-600-4421
Mailing Address - Fax:786-475-1414
Practice Address - Street 1:7420 W 18TH LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3717
Practice Address - Country:US
Practice Address - Phone:305-600-4421
Practice Address - Fax:786-475-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7178621332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies