Healthcare Provider Details

I. General information

NPI: 1801171996
Provider Name (Legal Business Name): PREMED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 CALLE RODRIGO DE TRIANA
SAN JUAN PR
00918-2807
US

IV. Provider business mailing address

251 CALLE RODRIGO DE TRIANA
SAN JUAN PR
00918-2807
US

V. Phone/Fax

Practice location:
  • Phone: 787-645-7774
  • Fax: 787-296-1030
Mailing address:
  • Phone: 787-645-7774
  • Fax: 787-296-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALBERTO MERCADO
Title or Position: OWNER
Credential:
Phone: 787-645-7774