Healthcare Provider Details

I. General information

NPI: 1326992470
Provider Name (Legal Business Name): HOME ORTHOPEDICS PR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE WILLIAM F BRENNAN. ZONA INDUSTRIAL
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

CALLE WILLIAM F BRENNAN. ZONA INDUSTRIAL
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-1002
  • Fax:
Mailing address:
  • Phone: 787-763-1002
  • Fax:

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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: IDOLKIS DIAZ
Title or Position: GENERAL MANAGER-COMPLIANCE AND SECU
Credential:
Phone: 787-763-1002