Provider Demographics
NPI:1538228515
Name:HOME ORTHOPEDICS CORP
Entity type:Organization
Organization Name:HOME ORTHOPEDICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-763-1002
Mailing Address - Street 1:202 CALLE FEDERICO COSTA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1321
Mailing Address - Country:US
Mailing Address - Phone:787-763-1002
Mailing Address - Fax:
Practice Address - Street 1:1045 CALLE WILLIAM F BRENNAN
Practice Address - Street 2:ZONA INDUSTRIAL GUANAJIBO, CARR. 114 KM 1.3
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1377
Practice Address - Country:US
Practice Address - Phone:787-763-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME ORTHOPEDICS CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-06
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0309920001Medicare NSC