Provider Demographics
NPI:1396139333
Name:MI AMANECER DME LLC
Entity type:Organization
Organization Name:MI AMANECER DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:JAIME
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-573-8047
Mailing Address - Street 1:2432 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-5694
Mailing Address - Country:US
Mailing Address - Phone:956-573-8047
Mailing Address - Fax:
Practice Address - Street 1:7208 W EXPRESSWAY 83 STE B
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-9501
Practice Address - Country:US
Practice Address - Phone:956-600-7163
Practice Address - Fax:956-600-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies