Provider Demographics
NPI:1063453843
Name:SUN RISE MEDICAL EQUIPMENT CORP.
Entity type:Organization
Organization Name:SUN RISE MEDICAL EQUIPMENT CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GERENTE GENERAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JOS
Authorized Official - Middle Name:V
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:--
Authorized Official - Phone:787-860-9259
Mailing Address - Street 1:55 ROSENDO MATIENZO CINTRON
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773
Mailing Address - Country:US
Mailing Address - Phone:787-889-2599
Mailing Address - Fax:787-889-2599
Practice Address - Street 1:#54 CALLE MATIENZO CINTRON
Practice Address - Street 2:PMB4
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-0000
Practice Address - Country:US
Practice Address - Phone:787-889-2599
Practice Address - Fax:787-889-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
57599OtherSSS
50445OtherPREFERRED MEDICAL
PR=========1Medicare NSC