Healthcare Provider Details

I. General information

NPI: 1326346206
Provider Name (Legal Business Name): PJ MEDICAL SUPPLIES AND PROSTHETICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 AVE AMERICO MIRANDA URB CAPARRA TERRACE
SAN JUAN PR
00921-2128
US

IV. Provider business mailing address

1418 AVE AMERICO MIRANDA URB CAPARRA TERRACE
SAN JUAN PR
00921-2128
US

V. Phone/Fax

Practice location:
  • Phone: 787-782-2866
  • Fax:
Mailing address:
  • Phone: 787-782-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StatePR

VIII. Authorized Official

Name: MR. JORGE R SERRAT
Title or Position: PRESIDENT
Credential:
Phone: 787-782-2866