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General NPI Number Information
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NPI Number | 1043557044
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Entity Type | Organization
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Legal Business Name | SJM SUPPLIES INC
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | MAIN ST 116
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City | GUANICA
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State | PR
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Zip | 00653-0000
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Country | US
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Telephone | 787-610-0656
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5167
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City | YAUCO
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State | PR
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Zip | 00698-5167
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Country | US
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Telephone | 787-610-0656
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOISSELT ACOSTA
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Credential |
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Telephone | 787-610-0656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | PR
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