Provider Demographics
NPI:1124221494
Name:JARROT SIERRA MAGNETIC STORE, INC
Entity Type:Organization
Organization Name:JARROT SIERRA MAGNETIC STORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-782-5767
Mailing Address - Street 1:AVE. JT PINERO # 1108
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-782-5767
Mailing Address - Fax:787-281-7476
Practice Address - Street 1:1108 AVE JESUS T PINERO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1722
Practice Address - Country:US
Practice Address - Phone:787-782-5767
Practice Address - Fax:787-261-7476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00210570014335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier