Healthcare Provider Details

I. General information

NPI: 1194775015
Provider Name (Legal Business Name): LABORATORIO ORTOPEDICO PROTESICO DE P.R.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND MENDEZ VIGO W
MAYAGUEZ PR
00680-2800
US

IV. Provider business mailing address

67 MENDEZ VIGO W
MAYAGUEZ PR
00680-2802
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0003
  • Fax: 787-834-4395
Mailing address:
  • Phone: 787-833-0003
  • Fax: 787-834-4395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberC22525
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberC22525
License Number StatePR

VIII. Authorized Official

Name: MRS. RUTH E. PEREZ
Title or Position: VICE- PRESIDENT
Credential:
Phone: 787-833-0003