Provider Demographics
NPI:1730179185
Name:DIABETIC CENTER & HOSPITAL SUPPLY INC
Entity type:Organization
Organization Name:DIABETIC CENTER & HOSPITAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-284-3997
Mailing Address - Street 1:PO BOX 8746
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8746
Mailing Address - Country:US
Mailing Address - Phone:787-284-3997
Mailing Address - Fax:787-284-3997
Practice Address - Street 1:2743 CALLE LAS CARROZAS
Practice Address - Street 2:URB PERLA DEL SUR
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0407
Practice Address - Country:US
Practice Address - Phone:787-284-3997
Practice Address - Fax:787-843-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRDI0300C332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50086DIOtherTRIPLE S
PR990168OtherMMM HEALTHCARE
PR9000688OtherCRUZ AZUL DE PR
PR9000688OtherCRUZ AZUL DE PR