Healthcare Provider Details

I. General information

NPI: 1659389997
Provider Name (Legal Business Name): AXISCARE HEALTH LOGISTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 19.5 PEPSI INDUSTRIAL PARK #1 CANDELARIA
TOA BAJA PR
00949
US

IV. Provider business mailing address

PO BOX 1366
DORADO PR
00646-1366
US

V. Phone/Fax

Practice location:
  • Phone: 787-251-2323
  • Fax: 787-251-2756
Mailing address:
  • Phone: 787-251-2323
  • Fax: 787-251-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. GUILLERMO ISMARO MARRERO
Title or Position: PRESIDENT
Credential:
Phone: 787-251-2323