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General NPI Number Information
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NPI Number | 1558070946
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Entity Type | Organization
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Legal Business Name | ORTHO ADVANCED LLC
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | TORRE MEDICA SAN LUCAS STE 507
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City | PONCE
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State | PR
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Zip | 00716
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Country | US
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Telephone | 787-840-7533
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Fax | 787-812-7533
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Provider Business Mailing Address
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Address Line | 609 AVE TITO CASTRO STE 102 PMB 386
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City | PONCE
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State | PR
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Zip | 00716-2232
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Country | US
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Telephone | 787-840-7533
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Fax | 787-812-7533
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAFAEL SENERIZ ORTIZ
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Credential | MD
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Telephone | 787-840-7533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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