Provider Demographics
NPI:1356125066
Name:EL MAMEY FRUTERIA CORP
Entity type:Organization
Organization Name:EL MAMEY FRUTERIA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-263-1763
Mailing Address - Street 1:4410 WEST 16TH AVE UNIT #10
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7101
Mailing Address - Country:US
Mailing Address - Phone:786-263-1763
Mailing Address - Fax:
Practice Address - Street 1:EL MAMEY FRUTERIA CORP
Practice Address - Street 2:4410 WEST 16TH AVE UNIT #10
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7101
Practice Address - Country:US
Practice Address - Phone:786-263-1763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals