Provider Demographics
NPI:1740429315
Name:PEQUIN DME-A SALSA INGREDIENT
Entity Type:Organization
Organization Name:PEQUIN DME-A SALSA INGREDIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-479-7704
Mailing Address - Street 1:4865 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3627
Mailing Address - Country:US
Mailing Address - Phone:210-479-0074
Mailing Address - Fax:210-479-2692
Practice Address - Street 1:14615 SAN PEDRO AVE
Practice Address - Street 2:STE 220
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4321
Practice Address - Country:US
Practice Address - Phone:210-479-7707
Practice Address - Fax:210-479-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0093615332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTSP14Medicare PIN