Provider Demographics
NPI:1326155979
Name:MOLINA MEDICAL EQUIPMENT CORP
Entity Type:Organization
Organization Name:MOLINA MEDICAL EQUIPMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-630-1506
Mailing Address - Street 1:P.O. BOX 1308
Mailing Address - Street 2:
Mailing Address - City:BAJADERO
Mailing Address - State:PR
Mailing Address - Zip Code:00616
Mailing Address - Country:US
Mailing Address - Phone:787-817-7171
Mailing Address - Fax:787-817-7171
Practice Address - Street 1:CARR. 639 KM. 1.8 SECT. CANDELARIA
Practice Address - Street 2:BO. SABANA HOYOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00688
Practice Address - Country:US
Practice Address - Phone:787-817-7171
Practice Address - Fax:787-817-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR159196332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5681670001Medicare NSC