Provider Demographics
NPI:1376544270
Name:ADVANCED RENT SALES MEDICAL
Entity Type:Organization
Organization Name:ADVANCED RENT SALES MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-844-4123
Mailing Address - Street 1:PO BOX 336839
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-6839
Mailing Address - Country:US
Mailing Address - Phone:787-844-4123
Mailing Address - Fax:787-842-8998
Practice Address - Street 1:139 CALLE VICTORIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733
Practice Address - Country:US
Practice Address - Phone:787-844-4123
Practice Address - Fax:787-842-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRAD0100C332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3504OtherAHM
PR55139ADOtherTRIPLE S - OPTIMO
PR840085OtherMMM
PR50925OtherPMC
PR3504OtherAHM