Healthcare Provider Details

I. General information

NPI: 1194022145
Provider Name (Legal Business Name): PUERTO RICO ADVANCE MEDICAL DEVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 AVE DOMENECH
SAN JUAN PR
00918-3511
US

IV. Provider business mailing address

35 CALLE JUAN C BORBON STE 67-333
GUAYNABO PR
00969-5374
US

V. Phone/Fax

Practice location:
  • Phone: 787-429-4369
  • Fax:
Mailing address:
  • Phone: 787-429-4369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANTONIO JESUS KRAEMER
Title or Position: PRESIDENT
Credential: BS
Phone: 787-429-4369