MEDICARE: MEDICAL & DME OF PR, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)

General Provider Information

NPI Number	:	1356395982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL & DME OF PR, INC

Provider Business Mailing Address
First Line	:	374 AVE ESCORIAL
Second Line	:	CAPARRA HEIGHTS
City	:	SAN JUAN
State	:	PR
Zip	:	00920-3507
Country	:	US
Telephone Number	:	787-783-6932
Fax Number	:

Provider Business Practice Location Address
First Line	:	1323 AVE JESUS T PINERO
Second Line	:	CAPARRA HEIGHTS
City	:	SAN JUAN
State	:	PR
Zip	:	00920-5503
Country	:	US
Telephone Number	:	787-783-6932
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ZENIA ESTHER DOPICO
Credential	:	NA
Telephone Number	:	787-783-6932

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	02/16/2010

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