Healthcare Provider Details

I. General information

NPI: 1558336610
Provider Name (Legal Business Name): MEDICAL EQUIPMENT & SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

V26 AVE MUNOZ MARIN URB MARIOLGA
CAGUAS PR
00725-6462
US

IV. Provider business mailing address

V26 AVENIDA MUNOZ MARIN URB MARIOLGA
CAGUAS PR
00725-6462
US

V. Phone/Fax

Practice location:
  • Phone: 787-704-0955
  • Fax: 787-704-0975
Mailing address:
  • Phone: 787-704-0955
  • Fax: 787-704-0975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4955390001
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: NEREIDA RODRIGUEZ OTERO
Title or Position: OWNER
Credential:
Phone: 787-704-0955