Provider Demographics
NPI:1356432728
Name:EQUIPMEDIC CORP
Entity type:Organization
Organization Name:EQUIPMEDIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTOLAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-798-1798
Mailing Address - Street 1:PO BOX 192469
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2469
Mailing Address - Country:US
Mailing Address - Phone:787-798-1798
Mailing Address - Fax:787-778-7651
Practice Address - Street 1:IF29 AVE LOMAS VERDES
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3114
Practice Address - Country:US
Practice Address - Phone:787-798-1798
Practice Address - Fax:787-778-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRB-24264332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1099450001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT