Provider Demographics
NPI:1063718591
Name:NATIONALITY MEDICAL DISTRIBUTORS, LLC
Entity type:Organization
Organization Name:NATIONALITY MEDICAL DISTRIBUTORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-360-4357
Mailing Address - Street 1:2545 W 80TH ST
Mailing Address - Street 2:13
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2740
Mailing Address - Country:US
Mailing Address - Phone:786-360-4357
Mailing Address - Fax:786-360-4429
Practice Address - Street 1:2545 W 80TH ST
Practice Address - Street 2:13
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2740
Practice Address - Country:US
Practice Address - Phone:786-360-4357
Practice Address - Fax:786-360-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies