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
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XX0005X18438PRY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine

No ID Information.


Home