Provider Demographics
NPI:1285497339
Name:ORTHOPEDIC AND SPINE CENTER OF PUERTO RICO LLC
Entity type:Organization
Organization Name:ORTHOPEDIC AND SPINE CENTER OF PUERTO RICO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGUAL PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-340-0913
Mailing Address - Street 1:2225 PONCE BY PASS
Mailing Address - Street 2:PARRA MEDICAL PLAZA 1003 1004
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-492-0014
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL DAMAS
Practice Address - Street 2:2225 PONCE BYPASS PARRA MEDICAL PLAZA SUITE 1003-1004
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1313
Practice Address - Country:US
Practice Address - Phone:787-492-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty