Healthcare Provider Details

I. General information

NPI: 1164403903
Provider Name (Legal Business Name): PK INDUSTRIES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 AVE RUIZ SOLER JARDINES DE CAPARRA
BAYAMON PR
00959-7841
US

IV. Provider business mailing address

3 AVE RUIZ SOLER JARDINES DE CAPARRA
BAYAMON PR
00959-7841
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-2500
  • Fax: 787-787-4296
Mailing address:
  • Phone: 787-798-2500
  • Fax: 787-787-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number04-P-1951
License Number StatePR

VIII. Authorized Official

Name: MR. JAIME JOSE INFANZON
Title or Position: MANAGER
Credential:
Phone: 787-798-2500