Provider Demographics
NPI:1396903142
Name:RONI'S BRAS & MASTECTOMY BOUTIQUE
Entity type:Organization
Organization Name:RONI'S BRAS & MASTECTOMY BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RONI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIENER
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:561-826-2727
Mailing Address - Street 1:3260 NORTH FEDERAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:561-826-2727
Mailing Address - Fax:561-826-2728
Practice Address - Street 1:3260 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6002
Practice Address - Country:US
Practice Address - Phone:561-826-2727
Practice Address - Fax:561-826-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5438160001Medicare NSC