Provider Demographics
NPI:1871925131
Name:MEDICAL LOGISTICS SERVICES
Entity type:Organization
Organization Name:MEDICAL LOGISTICS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILMARISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORRATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-370-3104
Mailing Address - Street 1:68 HACIENDA DEL LAGO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9216
Mailing Address - Country:US
Mailing Address - Phone:787-370-3104
Mailing Address - Fax:787-743-8999
Practice Address - Street 1:1449 CALLE AMERICO SALAS
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1908
Practice Address - Country:US
Practice Address - Phone:787-370-3104
Practice Address - Fax:787-743-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy