Provider Demographics
NPI:1780887349
Name:GRES ADVANCED DME
Entity type:Organization
Organization Name:GRES ADVANCED DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-396-9016
Mailing Address - Street 1:14439 NW MILITARY HWY # 449
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1646
Mailing Address - Country:US
Mailing Address - Phone:210-396-9016
Mailing Address - Fax:210-493-8875
Practice Address - Street 1:14439 NW MILITARY HWY # 449
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1646
Practice Address - Country:US
Practice Address - Phone:210-396-9016
Practice Address - Fax:210-493-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies