Provider Demographics
NPI:1699988410
Name:ELIEL ORTHO MEDICAL CORP
Entity type:Organization
Organization Name:ELIEL ORTHO MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:NOEMI
Authorized Official - Last Name:DIANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-754-2926
Mailing Address - Street 1:JESUS T PINIERO AVE 256B
Mailing Address - Street 2:UNIVERSITY GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-754-2926
Mailing Address - Fax:787-754-4259
Practice Address - Street 1:JESUS T PINIERO AVE 256B
Practice Address - Street 2:UNIVERSITY GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-754-2926
Practice Address - Fax:787-754-4259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR990436OtherPMC
PRG1261OtherTRIPLE S INC
PR999723OtherMMM
PR=========OtherHUMANA CHOICE
PR=========OtherHUMANA GOLD P
PR990436OtherPMC
PR=========OtherPAN AMERICAN LIFE
PRG1261OtherTRIPLE S INC
=========OtherCANADA LIFE
PR=========OtherMAPHRE MEDICARE
PR999723OtherMMM
PR=========OtherTRICARE