Provider Demographics
NPI:1013230549
Name:MMT MEDICAL SUPPLY CORP.
Entity Type:Organization
Organization Name:MMT MEDICAL SUPPLY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIZRAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-783-6807
Mailing Address - Street 1:URBANIZACION LAS LOMAS #772D
Mailing Address - Street 2:AVENIDA SAN PATRICIO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1303
Mailing Address - Country:US
Mailing Address - Phone:787-783-6807
Mailing Address - Fax:787-783-6807
Practice Address - Street 1:URBANIZACION LAS LOMAS #772D
Practice Address - Street 2:AVENIDA SAN PATRICIO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1303
Practice Address - Country:US
Practice Address - Phone:787-783-6807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MMT MEDICAL SUPPLY CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-11
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6451750001Medicare NSC