Provider Demographics
NPI:1265253470
Name:THE DME BOUTIQUE LLC
Entity type:Organization
Organization Name:THE DME BOUTIQUE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMONACID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-261-7081
Mailing Address - Street 1:8353 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6607
Mailing Address - Country:US
Mailing Address - Phone:954-505-4411
Mailing Address - Fax:954-272-7111
Practice Address - Street 1:2880 S OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-5431
Practice Address - Country:US
Practice Address - Phone:407-993-6323
Practice Address - Fax:954-272-7111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DME BOUTIQUE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024105100Medicaid