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General NPI Number Information
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NPI Number | 1114159563
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Entity Type | Organization
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Legal Business Name | ALTER EGO ORTHOPEDICS, P.S.C.
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Dates
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Enumeration Date | 08/19/2009
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 369 CALLE DE DIEGO SUITE 602 TORRE SAN FRANCISCO
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City | SAN JUAN
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State | PR
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Zip | 00923-3003
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Country | US
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Telephone | 787-688-3500
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Fax | 786-472-6851
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Provider Business Mailing Address
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Address Line | 138 AVE WINSTON CHURCHILL PMB 675
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City | SAN JUAN
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State | PR
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Zip | 00926-6013
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Country | US
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Telephone | 787-688-3500
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Fax | 786-472-6851
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIRYLSA COLON-MARTINEZ
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Credential | M.D.
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Telephone | 787-565-5021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 15626
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License Number State | PR
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