1609133206 NPI number — FERNANDEZ LOPEZ ORTHOPEDIC SERVICES PSC

Table of content: (NPI 1609133206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609133206 NPI number — FERNANDEZ LOPEZ ORTHOPEDIC SERVICES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FERNANDEZ LOPEZ ORTHOPEDIC SERVICES PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609133206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MONTEHIEDRA
Provider Second Line Business Mailing Address:
200 ZORZAL ST.
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-661-0368
Provider Business Mailing Address Fax Number:
787-790-6408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARIMED PLZ
Provider Second Line Business Practice Location Address:
B1 SANTA CRUZ ST.
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-6928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-798-7070
Provider Business Practice Location Address Fax Number:
787-787-2107
Provider Enumeration Date:
04/19/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FERNANDEZ
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-661-0368

Provider Taxonomy Codes

  • Taxonomy code: 207XP3100X , with the licence number:  8499 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)