Provider Demographics
NPI:1457727851
Name:HATO REY MEDICAL SUPPLIES & EQUIPMENTS LLC
Entity Type:Organization
Organization Name:HATO REY MEDICAL SUPPLIES & EQUIPMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMARIES
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MPH
Authorized Official - Phone:787-504-4000
Mailing Address - Street 1:24 CALLE MAYAGUEZ
Mailing Address - Street 2:HATO REY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-4916
Mailing Address - Country:US
Mailing Address - Phone:787-504-4000
Mailing Address - Fax:
Practice Address - Street 1:24 CALLE MAYAGUEZ
Practice Address - Street 2:HATO REY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-4916
Practice Address - Country:US
Practice Address - Phone:787-504-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011492332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies