Provider Demographics
NPI:1326318387
Name:EA SPORT MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:EA SPORT MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-909-8975
Mailing Address - Street 1:2F24 CALLE 6
Mailing Address - Street 2:VISTAS DEL CONVENTO
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3207
Mailing Address - Country:US
Mailing Address - Phone:787-909-8975
Mailing Address - Fax:787-863-7199
Practice Address - Street 1:ST 194 KM 3.0
Practice Address - Street 2:LOCAL 1
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-909-8975
Practice Address - Fax:787-863-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment