Healthcare Provider Details

I. General information

NPI: 1700116936
Provider Name (Legal Business Name): INSTITUTO ORTOPEDICO LABORAL, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 CALLE FONT MARTELO
HUMACAO PR
00791-3250
US

IV. Provider business mailing address

PO BOX 637
HUMACAO PR
00792-0637
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-6200
  • Fax: 787-852-6704
Mailing address:
  • Phone: 787-852-6800
  • Fax: 787-852-6704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number4133
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number4133
License Number StatePR

VIII. Authorized Official

Name: DR. JULIO ANGEL DE LA CRUZ - ROSSADO
Title or Position: CORPORATIVE PRESIDENT
Credential: MD
Phone: 787-852-6200