Healthcare Provider Details

I. General information

NPI: 1750478905
Provider Name (Legal Business Name): ATENAS MEDICAL SUPPLY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 URB ZENO
BARCELONETA PR
00617-3327
US

IV. Provider business mailing address

10 URB ZENO PO BOX 610
BARCELONETA PR
00617-3327
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-5919
  • Fax: 787-846-6186
Mailing address:
  • Phone: 787-846-5919
  • Fax: 787-846-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JUSTO P VAZQUEZ-DIAZ
Title or Position: RMO
Credential:
Phone: 787-846-5919