Healthcare Provider Details

I. General information

NPI: 1619014792
Provider Name (Legal Business Name): COQUI BLOOD SALVAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 CALLE AGUILA BOSQUE VERDE
CAGUAS PR
00727-6985
US

IV. Provider business mailing address

CALLE AGUILA # 112 BOSQUE VERDE
CAGUAS PR
00727-6985
US

V. Phone/Fax

Practice location:
  • Phone: 787-448-2931
  • Fax: 787-744-8359
Mailing address:
  • Phone: 787-448-2931
  • Fax: 787-744-8359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number168488
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL CARRILLO
Title or Position: PRESIDENT
Credential:
Phone: 787-448-2931