Provider Demographics
NPI:1083923833
Name:RUDY ORTHOMEDIC, CORP
Entity Type:Organization
Organization Name:RUDY ORTHOMEDIC, CORP
Other - Org Name:RUDY FARMACIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:OP
Authorized Official - Phone:787-880-6000
Mailing Address - Street 1:217 AVE JOSE DE DIEGO
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4547
Mailing Address - Country:US
Mailing Address - Phone:787-880-6000
Mailing Address - Fax:787-880-2221
Practice Address - Street 1:217 AVE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4547
Practice Address - Country:US
Practice Address - Phone:787-880-6000
Practice Address - Fax:787-880-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X
PR1912036732332B00000X
OHOP-7621335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies