Healthcare Provider Details

I. General information

NPI: 1235133125
Provider Name (Legal Business Name): BURGOS HOSPITAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A13 CALLE 13
BAYAMON PR
00957-1807
US

IV. Provider business mailing address

URB. SANTA MONICA A13 CALLE 13
BAYAMON PR
00957-1807
US

V. Phone/Fax

Practice location:
  • Phone: 787-288-2702
  • Fax: 787-288-2704
Mailing address:
  • Phone: 787-288-2702
  • Fax: 787-288-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number05- P 1848
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
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. ADALBERTO A. BURGOS
Title or Position: PRESIDENT
Credential:
Phone: 787-288-2702