Healthcare Provider Details

I. General information

NPI: 1760759922
Provider Name (Legal Business Name): DIABETIC SOLUTIONS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARIBBEAN MEDICAL CENTRE SUITE 101
PONCE PR
00731
US

IV. Provider business mailing address

PO BOX 8885 SABANA BRANCH
VEGA BAJA PR
00694-8885
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-6805
  • Fax: 787-840-6805
Mailing address:
  • Phone: 787-840-6805
  • Fax: 787-840-6805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JAIME XAVIER PANTOJA
Title or Position: PRESIDENT
Credential:
Phone: 787-608-8207