Provider Demographics
NPI:1386775724
Name:PRESTIGE PROFESSIONAL SERVICE CORP
Entity type:Organization
Organization Name:PRESTIGE PROFESSIONAL SERVICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YOSAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-970-4119
Mailing Address - Street 1:12355 SW 129TH CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6406
Mailing Address - Country:US
Mailing Address - Phone:786-242-9739
Mailing Address - Fax:
Practice Address - Street 1:12355 SW 129TH CT
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6406
Practice Address - Country:US
Practice Address - Phone:786-242-9739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies