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General NPI Number Information
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NPI Number | 1467668715
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Entity Type | Organization
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Legal Business Name | NORTHEN ORTHOPEDIC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 425 CARR 693 PM325
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City | DORADO
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State | PR
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Zip | 00646
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Country | US
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Telephone | 787-854-7979
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Fax | 787-884-3033
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Provider Business Mailing Address
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Address Line | 425 CARR 693 PMB 325
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City | DORADO
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State | PR
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Zip | 00646-4802
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Country | US
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Telephone | 787-854-7979
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Fax | 787-884-3033
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Authorized Official
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Title or Position | PRESIDENTE
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Name | DR. JUAN A RIOS FUENTES
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Credential | M.D.
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Telephone | 787-854-7979
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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 | 14033
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License Number State | PR
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