Provider Demographics
NPI:1962713131
Name:ORTHO EVOLUTION LLC
Entity type:Organization
Organization Name:ORTHO EVOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:CARRION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-621-2121
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:MANATI
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0787
Mailing Address - Country:US
Mailing Address - Phone:787-621-2121
Mailing Address - Fax:787-621-0818
Practice Address - Street 1:NUM 54 LOCAL 14 PLAZA PUERTA DEL SOL
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0000
Practice Address - Country:US
Practice Address - Phone:787-621-2121
Practice Address - Fax:787-621-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty