Healthcare Provider Details

I. General information

NPI: 1740838986
Provider Name (Legal Business Name): NAZARENO ENTERPRISES AND SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CALLE SANTA CRUZ
BAYAMON PR
00961-6906
US

IV. Provider business mailing address

28 CALLE SANTA CRUZ
BAYAMON PR
00961-6906
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-2934
  • Fax:
Mailing address:
  • Phone: 787-740-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. RAIMUNDO MATOS
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 787-740-2934