Provider Demographics
NPI:1063686780
Name:MILLENNIUM SURGICAL DEVICE
Entity Type:Organization
Organization Name:MILLENNIUM SURGICAL DEVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARIA - TESORERA
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:PADILLA
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-810-1487
Mailing Address - Street 1:PO BOX 6400
Mailing Address - Street 2:PMB 482
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-6400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:787-263-4758
Practice Address - Street 1:ESTANCIAS DE BETRIZ
Practice Address - Street 2:SAUCE #10
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-530-3766
Practice Address - Fax:787-263-4758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier