Provider Demographics
NPI:1669182259
Name:SAN LORENZO DURABLE MEDICAL EQUIPMENT LLC
Entity type:Organization
Organization Name:SAN LORENZO DURABLE MEDICAL EQUIPMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-799-3199
Mailing Address - Street 1:5819 SUN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-3517
Mailing Address - Country:US
Mailing Address - Phone:915-234-2830
Mailing Address - Fax:915-234-2831
Practice Address - Street 1:5819 SUN VALLEY DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-3517
Practice Address - Country:US
Practice Address - Phone:915-799-3199
Practice Address - Fax:915-234-2831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies