Healthcare Provider Details

I. General information

NPI: 1316945959
Provider Name (Legal Business Name): RENAL LIFE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 30 #200
BAYAMON PR
00956
US

IV. Provider business mailing address

138 AVE WINSTON CHURCHILL
SAN JUAN PR
00926-6013
US

V. Phone/Fax

Practice location:
  • Phone: 787-448-4448
  • Fax: 787-786-9824
Mailing address:
  • Phone: 787-448-4448
  • Fax: 787-786-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberTC-AMB 265
License Number StatePR

VIII. Authorized Official

Name: MR. JOSE A MARTINEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-448-4448