Provider Demographics
NPI:1689384919
Name:CORAL S M S CORP
Entity Type:Organization
Organization Name:CORAL S M S CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-688-6096
Mailing Address - Street 1:10211 W SAMPLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3966
Mailing Address - Country:US
Mailing Address - Phone:813-399-4385
Mailing Address - Fax:
Practice Address - Street 1:10211 W SAMPLE RD STE 100
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3966
Practice Address - Country:US
Practice Address - Phone:813-399-4385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies