Provider Demographics
NPI:1639100472
Name:DYNAMEDICS, INC.
Entity type:Organization
Organization Name:DYNAMEDICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-883-5778
Mailing Address - Street 1:90 AVE RIO HONDO
Mailing Address - Street 2:SUITE 267
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3105
Mailing Address - Country:US
Mailing Address - Phone:787-883-5778
Mailing Address - Fax:787-270-3110
Practice Address - Street 1:CARR #2 KM. 26.8 INT.
Practice Address - Street 2:CAMINO GUARISCO BO. ESPINOSA
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-883-5778
Practice Address - Fax:787-270-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5114830001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5114830001Medicare NSC