Provider Demographics
NPI:1710975578
Name:ESTRUCH MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:ESTRUCH MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-883-3700
Mailing Address - Street 1:PO BOX 1396
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-1396
Mailing Address - Country:US
Mailing Address - Phone:787-883-3700
Mailing Address - Fax:
Practice Address - Street 1:COM VILLA RETORNO LOC COM A-3
Practice Address - Street 2:CARR 690 KM 5.6 SUITE 1
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-2127
Practice Address - Country:US
Practice Address - Phone:787-883-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5377090001Medicare NSC