Provider Demographics
NPI:1194775015
Name:LABORATORIO ORTOPEDICO PROTESICO DE P.R.
Entity type:Organization
Organization Name:LABORATORIO ORTOPEDICO PROTESICO DE P.R.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE- PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-833-0003
Mailing Address - Street 1:67 MENDEZ VIGO W
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-2802
Mailing Address - Country:US
Mailing Address - Phone:787-833-0003
Mailing Address - Fax:787-834-4395
Practice Address - Street 1:COND MENDEZ VIGO W
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-2800
Practice Address - Country:US
Practice Address - Phone:787-833-0003
Practice Address - Fax:787-834-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRC225251744P3200X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0242520001Medicare NSC