Healthcare Provider Details

I. General information

NPI: 1386228286
Provider Name (Legal Business Name): CLINICA GERIATRIA Y ORTOPEDIA DEL OESTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 BO KM 119.2 BO CAIMITAL ALTO
AGUADILLA PR
00603
US

IV. Provider business mailing address

PO BOX 4808
AGUADILLA PR
00605-4808
US

V. Phone/Fax

Practice location:
  • Phone: 787-710-5835
  • Fax:
Mailing address:
  • Phone: 787-710-5835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWIN L PORTALATIN
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 787-710-5835