Provider Demographics
NPI:1417365859
Name:MILLIONAIRE FRESH INC
Entity type:Organization
Organization Name:MILLIONAIRE FRESH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-220-8672
Mailing Address - Street 1:15515 S VERMONT AVE
Mailing Address - Street 2:5
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4156
Mailing Address - Country:US
Mailing Address - Phone:323-220-8672
Mailing Address - Fax:
Practice Address - Street 1:98 VANDERFORD RD E
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5919
Practice Address - Country:US
Practice Address - Phone:904-589-0351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance