Provider Demographics
NPI:1124055173
Name:OCHUN PALMETTO BAY MEDICAL SUPPLIES INC.
Entity type:Organization
Organization Name:OCHUN PALMETTO BAY MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-303-8528
Mailing Address - Street 1:170 33 SOUTH DIXIE HWY
Mailing Address - Street 2:SUITE I
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 33 SOUTH DIXIE HWY
Practice Address - Street 2:SUITE I
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157
Practice Address - Country:US
Practice Address - Phone:786-303-8528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies