Healthcare Provider Details

I. General information

NPI: 1518117175
Provider Name (Legal Business Name): PONCE ORTHOPAEDIC TRAUMA INSTITUTE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BY PASS EDIFICIO PARRA OFICE 805
PONCE PR
00717-1321
US

IV. Provider business mailing address

URB. TERRA SENORIAL 141 CASTANIA
PONCE PR
00731
US

V. Phone/Fax

Practice location:
  • Phone: 718-710-6342
  • Fax:
Mailing address:
  • Phone: 718-710-6342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number17144
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number17144
License Number StatePR

VIII. Authorized Official

Name: DR. MICHAEL JOHN SERRA TORRES
Title or Position: OWNER
Credential: MD
Phone: 718-710-6342