Provider Demographics
NPI:1700967072
Name:FRESNILLO SUPPLIES INC
Entity Type:Organization
Organization Name:FRESNILLO SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRESNILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-964-7474
Mailing Address - Street 1:4290 10TH AVE N
Mailing Address - Street 2:UNIT 104
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2304
Mailing Address - Country:US
Mailing Address - Phone:561-964-7474
Mailing Address - Fax:561-964-7878
Practice Address - Street 1:4290 10TH AVE N
Practice Address - Street 2:UNIT 104
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-2304
Practice Address - Country:US
Practice Address - Phone:561-964-7474
Practice Address - Fax:561-964-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies