Provider Demographics
NPI:1780228577
Name:SO FLORIDA MEDICAL SUPPLY GROUP INC
Entity type:Organization
Organization Name:SO FLORIDA MEDICAL SUPPLY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALIESKI
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-786-4265
Mailing Address - Street 1:15190 SW 136TH ST STE 12
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2618
Mailing Address - Country:US
Mailing Address - Phone:786-429-1544
Mailing Address - Fax:786-513-7627
Practice Address - Street 1:15190 SW 136TH ST STE 12
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2618
Practice Address - Country:US
Practice Address - Phone:786-429-1544
Practice Address - Fax:786-513-7627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies