Organization
DIABETES SELF MANAGEMENT SUPPLIES
Active
Other names
Diabetes & Nutrition Centers
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY FONDA (PRESIDENT)
(561) 515-0848
Entity
Organization
Contact information
Practice address
12230 W FOREST HILL BLVD, SUITE 178, WELLINGTON, FL 33414-5700
(561) 515-0848
(561) 333-2640
Mailing address
12230 W FOREST HILL BLVD, SUITE 178, WELLINGTON, FL 33414-5700
(561) 515-0848
(561) 333-2640
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
09/29/2006
Last updated
02/10/2009
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