Healthcare Provider Details

I. General information

NPI: 1588844997
Provider Name (Legal Business Name): GOLDEN MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 DE INFANTERIA #67 SUITE B201
ANASCO PR
00610
US

IV. Provider business mailing address

PO BOX 84
ANASCO PR
00610-0084
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-0932
  • Fax: 787-826-6082
Mailing address:
  • Phone: 787-826-0932
  • Fax: 787-826-6082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number08P1621
License Number StatePR

VIII. Authorized Official

Name: CARLOS FRANCIS RIVERA
Title or Position: OWNER
Credential:
Phone: 787-826-0932