Provider Demographics
NPI:1699952523
Name:GRUPO ORTOPEDICO DEL ESTE C.S.P.
Entity type:Organization
Organization Name:GRUPO ORTOPEDICO DEL ESTE C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACON-BALADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-504-9848
Mailing Address - Street 1:1687 CALLE AMARILLO APT 3102
Mailing Address - Street 2:COND. LOS CEDROS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3065
Mailing Address - Country:US
Mailing Address - Phone:787-504-9848
Mailing Address - Fax:
Practice Address - Street 1:1687 CALLE AMARILLO APT 3102
Practice Address - Street 2:COND. LOS CEDROS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3065
Practice Address - Country:US
Practice Address - Phone:787-504-9848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16682207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty