Provider Demographics
NPI:1972799385
Name:JCC MEDICAL RENTAL CORP
Entity type:Organization
Organization Name:JCC MEDICAL RENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADALBERTO
Authorized Official - Middle Name:R
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-827-0804
Mailing Address - Street 1:2510 W 78TH ST
Mailing Address - Street 2:BAY I
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2510 W 78TH ST
Practice Address - Street 2:BAY I
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2705
Practice Address - Country:US
Practice Address - Phone:305-827-0804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL324345332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies