=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346710654
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORPORACION ORTOPEDIA INDUSTRIAL, CSP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2018
-----------------------------------------------------
Last Update Date | 11/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HOSPITAL INDUSTRIAL CENTRO MEDICO
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-754-2525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 70344 PMB 318
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-477-7757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JULIO R HERNANDEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-477-7757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------