Provider Demographics
NPI:1487716338
Name:EQUIPO MEDICO DE GURABO, CORP.
Entity type:Organization
Organization Name:EQUIPO MEDICO DE GURABO, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:CANCELADO BOAVITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-391-0099
Mailing Address - Street 1:7 ST. EL VIVERO F2
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-2338
Mailing Address - Country:US
Mailing Address - Phone:787-737-0840
Mailing Address - Fax:787-737-6088
Practice Address - Street 1:7ST. EL VIVERO F2
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-2338
Practice Address - Country:US
Practice Address - Phone:787-737-0840
Practice Address - Fax:787-737-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR97337332BX2000X
PRRFO01356335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50398OtherPREFERRED MEDICARE CHOICE
PR55220OtherBLUE CROSS BLUE SHIELD
PREQUIPOME01 EQ2005OtherINMEDIATA
PREQUIPOME01 EQ2005OtherINMEDIATA
PR1184520001Medicare NSC