# DIABETES SELF MANAGEMENT SUPPLIES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Diabetes & Nutrition Centers
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508958901
- **Authorized official:** JERRY FONDA (PRESIDENT)
- **Authorized official phone:** (561) 515-0848

## Contact information

- **Practice address:** 12230 W FOREST HILL BLVD, SUITE 178, WELLINGTON, FL 33414-5700
- **Practice address phone:** (561) 515-0848
- **Practice address fax:** (561) 333-2640
- **Mailing address:** 12230 W FOREST HILL BLVD, SUITE 178, WELLINGTON, FL 33414-5700
- **Mailing address phone:** (561) 515-0848
- **Mailing address fax:** (561) 333-2640

## Taxonomy

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

## Other

- **Enumeration date:** 09/29/2006
- **Last updated:** 02/10/2009