# DIVERSIFIED DME & SUPPLY CORP

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

## Provider details

- **NPI number:** 1194736918
- **Authorized official:** MRS. MARTHA R LACA (PRESIDENT)
- **Authorized official phone:** (305) 269-3838

## Contact information

- **Practice address:** 1700 S RED RD, SUITE 209, MIAMI, FL 33155-2163
- **Practice address phone:** (305) 269-3838
- **Practice address fax:** (305) 296-4141
- **Mailing address:** 1700 S RED RD, SUITE 209, MIAMI, FL 33155-2163
- **Mailing address phone:** (305) 269-3838
- **Mailing address fax:** (305) 296-4141

## Taxonomy

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

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 08/22/2020