1689940496 NPI number — ORTHOPAEDIC HAND AND UPPER EXTREMITY PSC

Table of content: (NPI 1689940496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689940496 NPI number — ORTHOPAEDIC HAND AND UPPER EXTREMITY PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC HAND AND UPPER EXTREMITY 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:
1689940496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
F15 CALLE SAN GABRIEL
Provider Second Line Business Mailing Address:
SAN PEDRO ESTATES
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725-7642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-415-0081
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COND PLAZA DE DIEGO
Provider Second Line Business Practice Location Address:
310 AVE DE DIEGO SUITE 301
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909-1730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-721-5505
Provider Business Practice Location Address Fax Number:
781-721-5388
Provider Enumeration Date:
03/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ ALVAREZ
Authorized Official First Name:
YESENIA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
ORTHOPAEDIC HAND SURGEON
Authorized Official Telephone Number:
787-415-0081

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X , with the licence number:  18200 , 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)





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