Provider Demographics
NPI:1316223100
Name:DIABETIC SOLUTIONS CORP
Entity Type:Organization
Organization Name:DIABETIC SOLUTIONS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:PANTOJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-608-8207
Mailing Address - Street 1:PO BOX 8885
Mailing Address - Street 2:SABANA BRANCH
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-8885
Mailing Address - Country:US
Mailing Address - Phone:787-608-8207
Mailing Address - Fax:787-763-2777
Practice Address - Street 1:ESTACIONAMIENTO CENTRO MEDICO LOCAL 2 RIO PIEDRAS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-763-2777
Practice Address - Fax:787-763-2777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIABETIC SOLUTIONS CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-25
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4952300003Medicare NSC