| NPI | 1487162632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILIZ BORBON BUMGARNER Owner 239-600-9389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME91688) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2025-06-20 |