Healthcare Provider Details

I. General information

NPI: 1407217789
Provider Name (Legal Business Name): CENTRO ORTOPEDICO INTEGRADO CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 AVE EDUARDO RUBERTE
PONCE PR
00717-0304
US

IV. Provider business mailing address

PO BOX 8726
PONCE PR
00732-8726
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-8000
  • Fax:
Mailing address:
  • Phone: 787-844-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: GILBERTO J ALVARADO DIAZ
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-844-8000