Healthcare Provider Details

I. General information

NPI: 1396854907
Provider Name (Legal Business Name): LAC MEDICAL EQUIPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE TOMAS CARRION MADURO #60
JUANA DIAZ PR
00795-1638
US

IV. Provider business mailing address

APARTADO 469
JUANA DIAZ PR
00795-0469
US

V. Phone/Fax

Practice location:
  • Phone: 787-937-5617
  • Fax: 787-837-5617
Mailing address:
  • Phone: 787-837-5617
  • Fax: 787-837-5617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number300OE
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number08P2347
License Number StatePR

VIII. Authorized Official

Name: BETSY L RAMOS
Title or Position: VICE PRESIDENTE
Credential:
Phone: 787-837-5617