1194775015 NPI number — LABORATORIO ORTOPEDICO PROTESICO DE P.R.

Table of content: (NPI 1194775015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194775015 NPI number — LABORATORIO ORTOPEDICO PROTESICO DE P.R.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO ORTOPEDICO PROTESICO DE P.R.
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:
1194775015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 MENDEZ VIGO W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00680-2802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-833-0003
Provider Business Mailing Address Fax Number:
787-834-4395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COND MENDEZ VIGO W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-833-0003
Provider Business Practice Location Address Fax Number:
787-834-4395
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
VICE- PRESIDENT
Authorized Official Telephone Number:
787-833-0003

Provider Taxonomy Codes

  • Taxonomy code: 1744P3200X , with the licence number:  C22525 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BC3200X , with the licence number: C22525 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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