Provider Demographics
NPI:1154445872
Name:SAN PABLO MEDICAL
Entity type:Organization
Organization Name:SAN PABLO MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-786-8895
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0610
Mailing Address - Country:US
Mailing Address - Phone:787-786-8895
Mailing Address - Fax:787-786-8895
Practice Address - Street 1:CALLE SANTA ROSA CRUZ 68
Practice Address - Street 2:TORRE SAN PABLO SUITE 1A
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-786-8895
Practice Address - Fax:787-786-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5225490001Medicare NSC