Provider Demographics
NPI:1699083741
Name:DIABETIC SOLUTIONS SOUTH CORP
Entity type:Organization
Organization Name:DIABETIC SOLUTIONS SOUTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:PANTOJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-608-8207
Mailing Address - Street 1:PO BOX 8885 SABANA BRANCH
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-8885
Mailing Address - Country:US
Mailing Address - Phone:787-763-2777
Mailing Address - Fax:787-763-2777
Practice Address - Street 1:ESTACIONAMIENTO CENTRO MEDICO LOCAL 2 RIO PIEDRAS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-763-2777
Practice Address - Fax:787-723-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment