Healthcare Provider Details

I. General information

NPI: 1144345240
Provider Name (Legal Business Name): PRO OXY RESPIRATORY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE AMERICO MIRANDA #951
SAN JUAN PR
00921-2801
US

IV. Provider business mailing address

951 AVE AMERICO MIRANDA
SAN JUAN PR
00921-2801
US

V. Phone/Fax

Practice location:
  • Phone: 787-749-9744
  • Fax: 787-754-1619
Mailing address:
  • Phone: 787-749-9744
  • Fax: 787-754-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number08P1347
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JAIME SEPULVEDA
Title or Position: PRESIDENT
Credential:
Phone: 787-749-9744