Provider Demographics
NPI:1598526337
Name:VENICE CENTER LLC
Entity Type:Organization
Organization Name:VENICE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUNIESKY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO DE LA COBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-307-0456
Mailing Address - Street 1:5298 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-8715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5298 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8715
Practice Address - Country:US
Practice Address - Phone:786-307-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies