Provider Demographics
NPI:1780770248
Name:SERGIO MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:SERGIO MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-486-2109
Mailing Address - Street 1:215 SW 17TH AVE
Mailing Address - Street 2:SUITE 309 A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3689
Mailing Address - Country:US
Mailing Address - Phone:786-486-2109
Mailing Address - Fax:
Practice Address - Street 1:215 SW 17TH AVE
Practice Address - Street 2:SUITE 309 A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3689
Practice Address - Country:US
Practice Address - Phone:786-486-2109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies