Provider Demographics
NPI:1447874979
Name:CRISTO MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:CRISTO MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ADOMANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-566-9165
Mailing Address - Street 1:4020 S 57TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4302
Mailing Address - Country:US
Mailing Address - Phone:561-566-9165
Mailing Address - Fax:844-640-0683
Practice Address - Street 1:4020 S 57TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4302
Practice Address - Country:US
Practice Address - Phone:561-566-9165
Practice Address - Fax:844-640-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies