Healthcare Provider Details

I. General information

NPI: 1174994685
Provider Name (Legal Business Name): ODISSEO INVESTMENT GROUP CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 CALLE 2 NE SUITE 2 ALTOS
SAN JUAN PR
00920-2534
US

IV. Provider business mailing address

1003 CALLE 2 NE URB PUERTO NUEVO
SAN JUAN PR
00920-2534
US

V. Phone/Fax

Practice location:
  • Phone: 787-404-7576
  • Fax:
Mailing address:
  • Phone:
  • 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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ULISES ORTIZ
Title or Position: PRESIDENT
Credential:
Phone: 787-404-7576