Organization
PONCE HOME MEDICAL EQUIPMENT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY CARVAJAL-PANTALEON M.S. (OWNER)
(904) 461-9050
Entity
Organization
Contact information
Practice address
1100 PLANTATION ISLAND DR S, SUITE 140, ST AUGUSTINE, FL 32080-6188
(904) 461-9050
(904) 461-9060
Mailing address
PO BOX 3123, ST AUGUSTINE, FL 32085-3123
(904) 824-4990
(904) 824-2226
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1313412
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000535300
—
FL
01
—
613159001
DOL
FL
Enumeration date
08/08/2008
Last updated
09/16/2011
Update your record
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