MEDICARE: SANTA MARIA MEDICAL SERVIES 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	:	1790788222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA MARIA MEDICAL SERVIES INC

Provider Business Mailing Address
First Line	:	PO BOX 8335
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-8335
Country	:	US
Telephone Number	:	787-841-4400
Fax Number	:	787-841-4400

Provider Business Practice Location Address
First Line	:	1575 AVE MUNOZ RIVERA
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00717-0211
Country	:	US
Telephone Number	:	787-841-4400
Fax Number	:	787-841-4400

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDNA I GRAU
Credential	:
Telephone Number	:	787-841-4400

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	08/22/2020

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