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General NPI Number Information
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NPI Number | 1467903708
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Entity Type | Organization
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Legal Business Name | SPORTMED INTERNATIONAL, LLC
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | S3-11 CARR 21 URB LAS LOMAS
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City | SAN JUAN
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State | PR
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Zip | 00921-3345
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Country | US
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Telephone | 787-534-3062
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Fax | 888-762-2577
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Provider Business Mailing Address
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Address Line | U12 CALLE 10 ALTURAS DE FLAMBOYAN
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City | BAYAMON
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State | PR
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Zip | 00959-8052
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Country | US
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Telephone | 787-534-3062
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Fax | 888-762-2577
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JORGE LUIS NAZARIO
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Credential |
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Telephone | 787-534-3062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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