Healthcare Provider Details

I. General information

NPI: 1265211007
Provider Name (Legal Business Name): ISMAEL RENTAS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

F1 CALLE ANTULIOS ESTANCIAS DE BAIROA
CAGUAS PR
00727-1244
US

IV. Provider business mailing address

F1 CALLE ANTULIOS
CAGUAS PR
00727-1244
US

V. Phone/Fax

Practice location:
  • Phone: 787-218-0819
  • Fax: 787-218-0819
Mailing address:
  • Phone: 787-218-0819
  • Fax: 787-218-0819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: ISMAEL RENTA
Title or Position: PRESIDENT
Credential: CBM
Phone: 787-218-0819