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General NPI Number Information
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NPI Number | 1528201175
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Entity Type | Organization
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Legal Business Name | MG ORTHOTICS AND PROSTHETICS CORP
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 8155 CALLE CONCORDIA SUITE 102
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City | PONCE
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State | PR
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Zip | 00717-1599
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Country | US
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Telephone | 787-812-7722
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Fax | 787-812-7722
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Provider Business Mailing Address
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Address Line | 530 MANSIONES DE COAMO
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City | COAMO
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State | PR
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Zip | 00769
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Country | US
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Telephone | 787-812-7722
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Fax | 787-812-7722
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MIGUEL A GOMEZ
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Credential |
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Telephone | 787-812-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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