1528201175 NPI number — MG ORTHOTICS AND PROSTHETICS CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528201175 NPI number — MG ORTHOTICS AND PROSTHETICS CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MG ORTHOTICS AND PROSTHETICS CORP
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:
1528201175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 MANSIONES DE COAMO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COAMO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-812-7722
Provider Business Mailing Address Fax Number:
787-812-7722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8155 CALLE CONCORDIA
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-1599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-812-7722
Provider Business Practice Location Address Fax Number:
787-812-7722
Provider Enumeration Date:
04/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
MIGUEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-812-7722

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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