MEDICARE: ODISSEO INVESTMENT GROUP CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1174994685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODISSEO INVESTMENT GROUP CORPORATION

Provider Business Mailing Address
First Line	:	1003 CALLE 2 NE
Second Line	:	URB PUERTO NUEVO
City	:	SAN JUAN
State	:	PR
Zip	:	00920-2534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 CALLE 2 NE
Second Line	:	SUITE 2 ALTOS
City	:	SAN JUAN
State	:	PR
Zip	:	00920-2534
Country	:	US
Telephone Number	:	787-404-7576
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ULISES ORTIZ
Credential	:
Telephone Number	:	787-404-7576

Provider Enumeration Date	:	10/09/2015
Last Update Date	:	10/09/2015

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