Provider Demographics
NPI:1669679577
Name:EQUIPO ENFERMERIA VISITANTE
Entity Type:Organization
Organization Name:EQUIPO ENFERMERIA VISITANTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-781-1714
Mailing Address - Street 1:A8 GENOVA ST
Mailing Address - Street 2:EXT VILLA CAPARRA
Mailing Address - City:GUYANABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-781-1714
Mailing Address - Fax:787-782-1029
Practice Address - Street 1:784 CAMPO RICO AVE
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-257-4790
Practice Address - Fax:787-257-4790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR038332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1282080001Medicare NSC