Organization
DIABETIC SHOE SOURCE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY H RIVERA C. PED (PRESIDENT)
(407) 323-5093
Entity
Organization
Contact information
Practice address
156 S CHARLES RICHARD BEALL BLVD, SUITE 3, DEBARY, FL 32713-3273
(407) 323-5093
(407) 386-8074
Mailing address
156 S CHARLES RICHARD BEALL BLVD, SUITE 3, DEBARY, FL 32713-3273
(407) 323-5093
(407) 386-8074
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
NOT REQUIRED
FL
Other
Enumeration date
03/28/2016
Last updated
03/28/2016
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