Healthcare Provider Details

I. General information

NPI: 1366445892
Provider Name (Legal Business Name): TU EQUIPO MEDICO ISLA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SUR RAMON E BETANCE
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

150 SUR RAMON E BETANCE
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-831-3583
  • Fax:
Mailing address:
  • Phone: 787-831-3583
  • Fax: 787-831-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number15-F3151
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5112310001
License Number StatePR

VIII. Authorized Official

Name: MR. MIGUEL ANGEL FIGUEROA
Title or Position: PRESIDENT
Credential:
Phone: 787-831-3583