Healthcare Provider Details

I. General information

NPI: 1750485454
Provider Name (Legal Business Name): PRO-MEDICAL EQUIPMENT, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 446 KM 0.3 BO. GUATEMALA
SAN SEBASTIAN PR
00685-4460
US

IV. Provider business mailing address

PO BOX 2071
SAN SEBASTIAN PR
00685-8071
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-2272
  • Fax: 787-280-1040
Mailing address:
  • Phone: 787-280-5031
  • Fax: 787-280-5036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. IVY ENID ROMAN IRIZARRY
Title or Position: PRESIDENT
Credential:
Phone: 787-922-4170