Provider Demographics
NPI:1821273400
Name:R/C EQUIPO MEDICO
Entity Type:Organization
Organization Name:R/C EQUIPO MEDICO
Other - Org Name:R/C EQUIPO MEDICO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:787-479-9043
Mailing Address - Street 1:PO BOX 1964
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-1964
Mailing Address - Country:US
Mailing Address - Phone:787-479-9043
Mailing Address - Fax:787-790-4300
Practice Address - Street 1:CARRETERA 169 K.M 7.2
Practice Address - Street 2:BARRIO CAMARONES
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970
Practice Address - Country:US
Practice Address - Phone:787-479-9043
Practice Address - Fax:787-790-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6129490001Medicare NSC