Healthcare Provider Details

I. General information

NPI: 1598627697
Provider Name (Legal Business Name): PUERTO RICO ORTHOPEDIC SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON STE 519
SAN JUAN PR
00917-5028
US

IV. Provider business mailing address

A18 CALLE PRINCIPE DE ASTURIAS
GUAYNABO PR
00969-5261
US

V. Phone/Fax

Practice location:
  • Phone: 787-772-1007
  • Fax:
Mailing address:
  • Phone: 787-459-2407
  • 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: DR. OMAR E RODRIGUEZ ALEJANDRO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-459-2407