Healthcare Provider Details

I. General information

NPI: 1649548363
Provider Name (Legal Business Name): ULTRACARE MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #2 KM 29.2 BARRIO ESPINOSA
VEGA ALTA PR
00692
US

IV. Provider business mailing address

PO BOX 844
MANATI PR
00674-0844
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-0700
  • Fax: 787-270-0706
Mailing address:
  • Phone: 787-270-0700
  • Fax: 787-270-0706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BRENDALITZ RIVERA DELGADO
Title or Position: OWNER
Credential:
Phone: 787-270-0700