Provider Demographics
NPI:1134139736
Name:ANTILLES SPECIALTY MEDICAL CORP.
Entity Type:Organization
Organization Name:ANTILLES SPECIALTY MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:BEATRIZ
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-253-3683
Mailing Address - Street 1:WA-2 MARGINAL ST EXT. LOS ANGELES
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:US
Mailing Address - Phone:787-253-3683
Mailing Address - Fax:787-791-8078
Practice Address - Street 1:WA-2 MARGINAL ST EXT. LOS ANGELES
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-253-3683
Practice Address - Fax:787-791-8078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies