Healthcare Provider Details

I. General information

NPI: 1629046685
Provider Name (Legal Business Name): EBJ ORTHOTICS & MEDICAL EQUIPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3172 AVE. DEL VALLE LEVITTOWN
TOA BAJA PR
00949
US

IV. Provider business mailing address

3172 PASEO CRESTA LEVITTOWN
TOA BAJA PR
00949-3130
US

V. Phone/Fax

Practice location:
  • Phone: 787-261-6500
  • Fax: 787-261-3825
Mailing address:
  • Phone: 787-261-6500
  • Fax: 787-261-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. EDNA DIAZ
Title or Position: PRESIDENT
Credential: MBA
Phone: 787-261-6500