Provider Demographics
NPI:1902808108
Name:NAZARENO ENTERPRISES AND SERVICES LLC
Entity type:Organization
Organization Name:NAZARENO ENTERPRISES AND SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, BOCPO
Authorized Official - Phone:787-740-2934
Mailing Address - Street 1:28 CALLE SANTA CRUZ
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6906
Mailing Address - Country:US
Mailing Address - Phone:787-740-2934
Mailing Address - Fax:787-288-0704
Practice Address - Street 1:28 CALLE SANTA CRUZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6906
Practice Address - Country:US
Practice Address - Phone:787-740-2934
Practice Address - Fax:787-288-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1143330001Medicare PIN
PR1143330001Medicare NSC