1326155979 NPI number — MOLINA MEDICAL EQUIPMENT CORP

Table of content: (NPI 1326155979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326155979 NPI number — MOLINA MEDICAL EQUIPMENT CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOLINA MEDICAL EQUIPMENT CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326155979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAJADERO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-817-7171
Provider Business Mailing Address Fax Number:
787-817-7171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 639 KM. 1.8 SECT. CANDELARIA
Provider Second Line Business Practice Location Address:
BO. SABANA HOYOS
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-817-7171
Provider Business Practice Location Address Fax Number:
787-817-7171
Provider Enumeration Date:
08/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOLINA
Authorized Official First Name:
MARCO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
787-630-1506

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  159196 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)