Provider Demographics
NPI:1093927741
Name:SANTA ROSA MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:SANTA ROSA MEDICAL EQUIPMENT INC
Other - Org Name:SANTA ROSA MEDICAL EQUIPMENT INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JATNIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-780-7563
Mailing Address - Street 1:Q 7 CALLE 15
Mailing Address - Street 2:URB VERSALLES
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-2131
Mailing Address - Country:US
Mailing Address - Phone:787-780-7563
Mailing Address - Fax:
Practice Address - Street 1:Q 7 CALLE 15
Practice Address - Street 2:URB. VERSALLES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-2131
Practice Address - Country:US
Practice Address - Phone:787-780-7563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5199150001Medicare NSC