Provider Demographics
NPI:1851337414
Name:TAVAREZ MEDICAL SUPPLY
Entity Type:Organization
Organization Name:TAVAREZ MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUENO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-830-5160
Mailing Address - Street 1:PO BOX 956
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0956
Mailing Address - Country:US
Mailing Address - Phone:787-830-5160
Mailing Address - Fax:787-830-5160
Practice Address - Street 1:JUAN HERNADEZ #7 EDIF. TAVAREZ
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-0000
Practice Address - Country:US
Practice Address - Phone:787-830-5160
Practice Address - Fax:787-830-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1154480001Medicare ID - Type Unspecified