Provider Demographics
NPI:1003070897
Name:MILLENIUM MEDICAL SUPPLY & EQUIPMENT CORP
Entity type:Organization
Organization Name:MILLENIUM MEDICAL SUPPLY & EQUIPMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YOKANI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANTIAGO LOPEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-885-4141
Mailing Address - Street 1:CALLE MATIENZO CINTRON #54
Mailing Address - Street 2:PMB 4
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-2152
Mailing Address - Country:US
Mailing Address - Phone:787-885-4141
Mailing Address - Fax:787-885-3795
Practice Address - Street 1:CALLE EFRAIN CORSINO
Practice Address - Street 2:PLAZA DEL MERCADO LOCAL #10
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773
Practice Address - Country:US
Practice Address - Phone:787-885-4141
Practice Address - Fax:787-885-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR277507 ARPE332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies