Provider Demographics
NPI:1144345240
Name:PRO OXY RESPIRATORY SERVICES INC
Entity type:Organization
Organization Name:PRO OXY RESPIRATORY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-749-9744
Mailing Address - Street 1:951 AVE AMERICO MIRANDA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2801
Mailing Address - Country:US
Mailing Address - Phone:787-749-9744
Mailing Address - Fax:787-754-1619
Practice Address - Street 1:AVE AMERICO MIRANDA
Practice Address - Street 2:#951
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2801
Practice Address - Country:US
Practice Address - Phone:787-749-9744
Practice Address - Fax:787-754-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X
PR08P1347332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1001130001Medicare NSC