Provider Demographics
NPI:1386355618
Name:PREMIUM MOBILITY LLC
Entity type:Organization
Organization Name:PREMIUM MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:786-451-8130
Mailing Address - Street 1:2577 JARDIN DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1514
Mailing Address - Country:US
Mailing Address - Phone:786-451-8130
Mailing Address - Fax:
Practice Address - Street 1:1249 STIRLING RD STE 3-4
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-3554
Practice Address - Country:US
Practice Address - Phone:786-451-8130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies