Provider Demographics
NPI:1942960208
Name:ICELAND MEDICAL EQUIPMENT CORP
Entity Type:Organization
Organization Name:ICELAND MEDICAL EQUIPMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAGOBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ AGUILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-413-6356
Mailing Address - Street 1:772 NW 72 AVE
Mailing Address - Street 2:SUITE 1127
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126
Mailing Address - Country:US
Mailing Address - Phone:305-413-6356
Mailing Address - Fax:
Practice Address - Street 1:777 NW 72ND AVE STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3009
Practice Address - Country:US
Practice Address - Phone:786-360-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies