Provider Demographics
NPI:1770175275
Name:BE UNBEWEAVEABLE
Entity type:Organization
Organization Name:BE UNBEWEAVEABLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAYANITSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURICIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-748-3468
Mailing Address - Street 1:404 POINCIANA DR
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4533
Mailing Address - Country:US
Mailing Address - Phone:305-748-3468
Mailing Address - Fax:
Practice Address - Street 1:18117 BISCAYNE BLVD STE 2168
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2535
Practice Address - Country:US
Practice Address - Phone:305-748-3468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier