# SUPRAMED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760427744
- **Authorized official:** DR. JORGE CARBALLIDO (ADMINISTRATOR)
- **Authorized official phone:** (787) 759-6265

## Contact information

- **Practice address:** DE DIEGO AVENUE \#359 ALTOS, \#319 ALTOS, RIO PIEDRAS, PR 00923
- **Practice address phone:** (787) 759-6265
- **Mailing address:** ROAD \#19 GARDEN HILL PLAZA \#1353, PMB \#228, GUAYNABO, PR 00966
- **Mailing address phone:** (787) 759-6265

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | TCAMB-108 | PR | Yes |

## Other

- **Enumeration date:** 06/16/2006
- **Last updated:** 08/22/2020