Provider Demographics
NPI:1063572345
Name:MICALELA MEDICAL SERVIES INC.
Entity type:Organization
Organization Name:MICALELA MEDICAL SERVIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-874-2466
Mailing Address - Street 1:6595 NW 36TH ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6979
Mailing Address - Country:US
Mailing Address - Phone:305-874-2466
Mailing Address - Fax:305-874-2465
Practice Address - Street 1:6595 NW 36TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6979
Practice Address - Country:US
Practice Address - Phone:305-874-2466
Practice Address - Fax:305-874-2465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING AHCA LIC#332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDING PROVIDER #Medicare ID - Type UnspecifiedMEDICARE HME PROVIDER