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General NPI Number Information
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NPI Number | 1215266564
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Entity Type | Organization
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Legal Business Name | BROKEN BONE ORTHO CSP
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 369 CALLE DE DIEGO STE 202 TORRE SAN FRANCISCO
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City | SAN JUAN
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State | PR
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Zip | 00923-3004
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Country | US
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Telephone | 787-756-6999
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Fax | 787-765-7880
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Provider Business Mailing Address
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Address Line | PO BOX 366905
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City | SAN JUAN
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State | PR
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Zip | 00936-6905
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Country | US
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Telephone | 787-756-6999
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Fax | 787-765-7880
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAFAEL OTERO
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Credential | MD
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Telephone | 787-756-6999
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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 | 4470
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License Number State | PR
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