Provider Demographics
NPI:1730165580
Name:ORTOPEDAS ASOCIADOS DEL OESTE
Entity type:Organization
Organization Name:ORTOPEDAS ASOCIADOS DEL OESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTALATIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-834-1575
Mailing Address - Street 1:1065 CORAZONES AVE
Mailing Address - Street 2:PROFESIONAL MEDICAL BUILDING 102
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-834-1575
Mailing Address - Fax:787-831-1011
Practice Address - Street 1:1065 CORAZONES AVE
Practice Address - Street 2:PROFESIONAL MEDICAL BUILDING 102
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-1575
Practice Address - Fax:787-831-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29158Medicare ID - Type Unspecified