MEDICARE: DIABETIC CENTER & HOSPITAL SUPPLY INC

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	332B00000X	Durable Medical Equipment & Medical Supplies	DI0300C	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50086DI	OTHER	PR	TRIPLE S
2	990168	OTHER	PR	MMM HEALTHCARE
3	9000688	OTHER	PR	CRUZ AZUL DE PR

General Provider Information

NPI Number	:	1730179185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETIC CENTER & HOSPITAL SUPPLY INC

Provider Business Mailing Address
First Line	:	PO BOX 8746
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-8746
Country	:	US
Telephone Number	:	787-284-3997
Fax Number	:	787-284-3997

Provider Business Practice Location Address
First Line	:	2743 CALLE LAS CARROZAS
Second Line	:	URB PERLA DEL SUR
City	:	PONCE
State	:	PR
Zip	:	00717-0407
Country	:	US
Telephone Number	:	787-284-3997
Fax Number	:	787-843-0014

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RAMON BONILLA
Credential	:
Telephone Number	:	787-284-3997

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	10/08/2011

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Directions to “DIABETIC CENTER & HOSPITAL SUPPLY INC ” Practice Location

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