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General NPI Number Information
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NPI Number | 1629471933
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Entity Type | Organization
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Legal Business Name | INNOVASIVE MEDICAL INC
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | ESTANCIAS DEL BLVD 7000 CARR. 844, APT. 6A6
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City | SAN JUAN
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State | PR
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Zip | 00926-9570
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Country | US
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Telephone | 787-414-7607
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Fax | 188-887-1961
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Provider Business Mailing Address
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Address Line | PO BOX 367968
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City | SAN JUAN
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State | PR
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Zip | 00936-7968
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Country | US
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Telephone | 787-414-7607
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Fax | 188-887-1961
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. HENRY RODRIGUEZ
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Credential |
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Telephone | 787-414-7607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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