Mavidala Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MAVIDALA SUPPLY LLC

Practice address

701 Tillery St Ste 12
Austin, TX 78702-3751

Phone

(830) 476-2811

NPI assigned

Jul 30, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Azra Majeed

Title

Ceo

Phone

(830) 476-2811

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699747200000",
    "number": "1447986583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 TILLERY ST STE 12",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787023751",
            "telephone_number": "830-476-2811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 TILLERY ST STE 12",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787023751",
            "telephone_number": "830-476-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAVIDALA SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-30",
        "last_updated": "2023-11-12",
        "certification_date": "2023-11-12",
        "status": "A",
        "authorized_official_last_name": "MAJEED",
        "authorized_official_first_name": "AZRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "830-476-2811"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.