Provider Demographics
NPI:1982796942
Name:MEDIRENTAL CORPORATION
Entity type:Organization
Organization Name:MEDIRENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-785-1240
Mailing Address - Street 1:AVE. LAUREL # 2E - 11
Mailing Address - Street 2:URB LOMAS VERDES
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3342
Mailing Address - Country:US
Mailing Address - Phone:787-785-1240
Mailing Address - Fax:787-785-1850
Practice Address - Street 1:AVE. LAUREL # 2E - 11
Practice Address - Street 2:URB LOMAS VERDES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3342
Practice Address - Country:US
Practice Address - Phone:787-785-1240
Practice Address - Fax:787-785-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0857490001Medicare ID - Type Unspecified