Provider Demographics
NPI:1578120614
Name:CHRODIMAT, LLC
Entity Type:Organization
Organization Name:CHRODIMAT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALICEA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:787-629-5974
Mailing Address - Street 1:HC 1 BOX 29030
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-8900
Mailing Address - Country:US
Mailing Address - Phone:787-629-5974
Mailing Address - Fax:800-676-1864
Practice Address - Street 1:H103 VILLAS DEL MAR BEACH RESORT
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-629-5974
Practice Address - Fax:800-676-1864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment