Healthcare Provider Details

I. General information

NPI: 1245486828
Provider Name (Legal Business Name): EL REDENTOR MEDICAL SUPPLIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALLE CELIS AGUILERA
MANATI PR
00674-5171
US

IV. Provider business mailing address

PO BOX 2338
MANATI PR
00674-2338
US

V. Phone/Fax

Practice location:
  • Phone: 787-904-3404
  • Fax: 787-854-9100
Mailing address:
  • Phone: 787-904-3404
  • Fax: 787-854-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. LICETTE MALDONADO
Title or Position: PRESIDENT
Credential:
Phone: 787-904-3404