# KEVIN ROSS SUPPLY CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154482073
- **Authorized official:** ONEIDA DIAZ LICEA (PRESIDENT)
- **Authorized official phone:** (305) 232-2006

## Contact information

- **Practice address:** 15715 S DIXIE HWY, SUITE 410, MIAMI, FL 33157-1800
- **Practice address phone:** (305) 232-2006
- **Mailing address:** 15715 S DIXIE HWY, SUITE 410, MIAMI, FL 33157-1800
- **Mailing address phone:** (305) 232-2006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 12/13/2006
- **Last updated:** 08/22/2020