Healthcare Provider Details

I. General information

NPI: 1023456860
Provider Name (Legal Business Name): ORTHOPAEDICS AND ARTHROSCOPIC INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAYAMON MEDICAL PLAZA PISO 7 SUITE 701
BAYAMON PR
00959-7200
US

IV. Provider business mailing address

116 CALLE JUAN LINES RAMOS URB FRONTERAS
BAYAMON PR
00961-2915
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-5500
  • Fax:
Mailing address:
  • Phone: 787-475-3747
  • Fax: 787-854-1452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number18438
License Number StatePR

VIII. Authorized Official

Name: DR. EDIL O JIMENEZ PEREZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-475-3747