Provider Demographics
NPI:1578919882
Name:SAN JUAN DME
Entity Type:Organization
Organization Name:SAN JUAN DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-781-8600
Mailing Address - Street 1:2604 N RAUL LONGORIA RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-4283
Mailing Address - Country:US
Mailing Address - Phone:956-781-8600
Mailing Address - Fax:956-781-8606
Practice Address - Street 1:2604 N RAUL LONGORIA RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-4283
Practice Address - Country:US
Practice Address - Phone:956-781-8600
Practice Address - Fax:956-781-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies