Provider Demographics
NPI:1750180717
Name:ELITE MEDICAL GLOBAL PUERTO RICO, LLC
Entity type:Organization
Organization Name:ELITE MEDICAL GLOBAL PUERTO RICO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ PARRILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-312-7451
Mailing Address - Street 1:URB LA CUMBRE
Mailing Address - Street 2:267 CALLE SIERRA MORENA PMB 64
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-312-7451
Mailing Address - Fax:
Practice Address - Street 1:CUPEY ALTO
Practice Address - Street 2:CARR 176 KM3.5 CAMINO LOS MARREROS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-312-7451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies