Basic Information
Provider Information | |||||||||
NPI: | 1023456860 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ORTHOPAEDICS AND ARTHROSCOPIC INSTITUTE | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 116 CALLE JUAN LINES RAMOS | ||||||||
Address2: | URB FRONTERAS | ||||||||
City: | BAYAMON | ||||||||
State: | PR | ||||||||
PostalCode: | 009612915 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7874753747 | ||||||||
FaxNumber: | 7878541452 | ||||||||
Practice Location | |||||||||
Address1: | BAYAMON MEDICAL PLAZA | ||||||||
Address2: | PISO 7 SUITE 701 | ||||||||
City: | BAYAMON | ||||||||
State: | PR | ||||||||
PostalCode: | 009597200 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877985500 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/13/2013 | ||||||||
LastUpdateDate: | 08/27/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | JIMENEZ PEREZ | ||||||||
AuthorizedOfficialFirstName: | EDIL | ||||||||
AuthorizedOfficialMiddleName: | O | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 7874753747 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 18438 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.