Healthcare Provider Details

I. General information

NPI: 1578560447
Provider Name (Legal Business Name): HOME ORTHOPEDICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CALLE FEDERICO COSTA URB TRES MONJITAS
SAN JUAN PR
00918-1321
US

IV. Provider business mailing address

202 CALLE FEDERICO COSTA URB TRES MONJITAS
SAN JUAN PR
00918-1321
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-1002
  • Fax: 787-763-1004
Mailing address:
  • Phone: 787-763-1002
  • Fax: 787-763-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JESUS G RODRIGUEZ
Title or Position: PRESIDENT
Credential: CPO
Phone: 787-763-1002