Provider Demographics
NPI:1891891271
Name:CRISTY MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:CRISTY MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-319-3945
Mailing Address - Street 1:2500 NW 79TH AVE
Mailing Address - Street 2:STE: 253
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1073
Mailing Address - Country:US
Mailing Address - Phone:786-319-3945
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 79TH AVE
Practice Address - Street 2:STE: 253
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1073
Practice Address - Country:US
Practice Address - Phone:786-319-3945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID