Healthcare Provider Details

I. General information

NPI: 1689940496
Provider Name (Legal Business Name): ORTHOPAEDIC HAND AND UPPER EXTREMITY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND PLAZA DE DIEGO 310 AVE DE DIEGO SUITE 301
SAN JUAN PR
00909-1730
US

IV. Provider business mailing address

F15 CALLE SAN GABRIEL SAN PEDRO ESTATES
CAGUAS PR
00725-7642
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-5505
  • Fax: 781-721-5388
Mailing address:
  • Phone: 787-415-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number18200
License Number StatePR

VIII. Authorized Official

Name: DR. YESENIA MARIA RODRIGUEZ ALVAREZ
Title or Position: ORTHOPAEDIC HAND SURGEON
Credential: MD
Phone: 787-415-0081