Healthcare Provider Details

I. General information

NPI: 1427387323
Provider Name (Legal Business Name): WESTSIDE MEDICAL SUPPLY,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 03/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE VICTORIA 33B
ANASCO PR
00610-0000
US

IV. Provider business mailing address

CALLE VICTORIA 33B
ANASCO PR
00610-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-7502
  • Fax: 787-826-7500
Mailing address:
  • Phone: 787-826-7502
  • Fax: 787-826-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JAROSET MORALES
Title or Position: PRESIDENT
Credential:
Phone: 787-826-7502