Healthcare Provider Details

I. General information

NPI: 1649392556
Provider Name (Legal Business Name): HEALTH CARE CENTER OF ORTHOTICS AND PROSTHETICS OF PR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 CALLE GUARIONEX
SAN JUAN PR
00918-4408
US

IV. Provider business mailing address

2852 HARTLAND RD
FALLS CHURCH VA
22043-3526
US

V. Phone/Fax

Practice location:
  • Phone: 787-946-4225
  • Fax:
Mailing address:
  • Phone: 571-436-7389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number165387
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number165387
License Number StatePR

VIII. Authorized Official

Name: MR. RICHARD MICHAEL GUARRASI
Title or Position: OWNER
Credential: CPO
Phone: 571-436-7389