1063453843 NPI number — SUN RISE MEDICAL EQUIPMENT CORP.

Table of content: (NPI 1063453843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063453843 NPI number — SUN RISE MEDICAL EQUIPMENT CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUN RISE 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:
1063453843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 ROSENDO MATIENZO CINTRON
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUQUILLO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-889-2599
Provider Business Mailing Address Fax Number:
787-889-2599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#54 CALLE MATIENZO CINTRON
Provider Second Line Business Practice Location Address:
PMB4
Provider Business Practice Location Address City Name:
LUQUILLO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00773-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-889-2599
Provider Business Practice Location Address Fax Number:
787-889-2599
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
JOS
Authorized Official Middle Name:
V
Authorized Official Title or Position:
GERENTE GENERAL
Authorized Official Telephone Number:
787-860-9259

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  1 , 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)

  • Identifier: 57599 . This is a "SSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50445 . This is a "PREFERRED MEDICAL" identifier . This identifiers is of the category "OTHER".




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