MEDICARE: EQUIPO MEDICO DE GURABO, CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	97337	PR
2	335E00000X	Prosthetic/Orthotic Supplier	RFO01356	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50398	OTHER	PR	PREFERRED MEDICARE CHOICE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	55220	OTHER	PR	BLUE CROSS BLUE SHIELD
3	EQUIPOME01 EQ2005	OTHER	PR	INMEDIATA

General Provider Information

NPI Number	:	1487716338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EQUIPO MEDICO DE GURABO, CORP.

Provider Business Mailing Address
First Line	:	7 ST. EL VIVERO F2
Second Line	:
City	:	GURABO
State	:	PR
Zip	:	00778-2338
Country	:	US
Telephone Number	:	787-737-0840
Fax Number	:	787-737-6088

Provider Business Practice Location Address
First Line	:	7ST. EL VIVERO F2
Second Line	:
City	:	GURABO
State	:	PR
Zip	:	00778-2338
Country	:	US
Telephone Number	:	787-737-0840
Fax Number	:	787-737-6088

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. JOSE RAUL CANCELADO BOAVITA
Credential	:
Telephone Number	:	787-391-0099

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	09/11/2025

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Directions to “EQUIPO MEDICO DE GURABO, CORP. ” Practice Location

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