Provider Demographics
NPI:1770909020
Name:DYNA-TECH MEDICAL SUPPLIES
Entity type:Organization
Organization Name:DYNA-TECH MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:BERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-556-5282
Mailing Address - Street 1:15835 WOODLAND SPRING CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6769
Mailing Address - Country:US
Mailing Address - Phone:407-556-5282
Mailing Address - Fax:
Practice Address - Street 1:15835 WOODLAND SPRING CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6769
Practice Address - Country:US
Practice Address - Phone:407-556-5282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies