Healthcare Provider Details

I. General information

NPI: 1750180717
Provider Name (Legal Business Name): ELITE MEDICAL GLOBAL PUERTO RICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CUPEY ALTO CARR 176 KM3.5 CAMINO LOS MARREROS
SAN JUAN PR
00926
US

IV. Provider business mailing address

URB LA CUMBRE 267 CALLE SIERRA MORENA PMB 64
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-312-7451
  • Fax:
Mailing address:
  • Phone: 787-312-7451
  • 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: MR. LUIS HERNANDEZ PARRILLA
Title or Position: VICE PRESIDENTE
Credential:
Phone: 787-312-7451