Healthcare Provider Details

I. General information

NPI: 1306162417
Provider Name (Legal Business Name): ORTHOPREMIUM MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA CLEMENTINA ST. B7-B
GUAYNABO PR
00969
US

IV. Provider business mailing address

300 AVE LA SIERRA BOX 122
SAN JUAN PR
00926-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-720-4042
  • Fax: 787-720-4014
Mailing address:
  • Phone: 787-720-4042
  • Fax: 787-720-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. RAUL SIERRA
Title or Position: OWNER
Credential:
Phone: 787-720-4042