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General NPI Number Information
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NPI Number | 1649401654
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Entity Type | Organization
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Legal Business Name | MEDEXPRESS DIABETIC SUPPLY
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Dates
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Enumeration Date | 08/07/2009
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Last Update Date | 08/07/2009
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Provider Practice Location Address
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Address Line | 324 CALLE PALACIOS APT 4
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City | SAN JUAN
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State | PR
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Zip | 00915-2165
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Country | US
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Telephone | 787-636-6496
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Fax |
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Provider Business Mailing Address
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Address Line | 324 CALLE PALACIOS APT 4
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City | SAN JUAN
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State | PR
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Zip | 00915-2165
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Country | US
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Telephone | 787-636-6496
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Fax |
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Authorized Official
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Title or Position | PROPIETARIO
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Name | MR. RAFAEL ROSARIO PEGUERO
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Credential |
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Telephone | 787-636-6496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | PR
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Taxonomy #2
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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 | PR
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