Healthcare Provider Details

I. General information

NPI: 1326017294
Provider Name (Legal Business Name): MANATI MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E26 CALLE HERNANDEZ CARRION URB ATENAS
MANATI PR
00674-4658
US

IV. Provider business mailing address

E26 CALLE HERNANDEZ CARRION URB ATENAS
MANATI PR
00674-4658
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-7960
  • Fax:
Mailing address:
  • Phone: 787-854-7960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4706370001
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. CARMEN OYOLA
Title or Position: OWNER
Credential:
Phone: 787-854-7960