Provider Demographics
NPI:1114172459
Name:MAYAGUEZ ORTHOPEDICS P S C
Entity Type:Organization
Organization Name:MAYAGUEZ ORTHOPEDICS P S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-652-3800
Mailing Address - Street 1:PO BOX 1508
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1508
Mailing Address - Country:US
Mailing Address - Phone:787-834-1575
Mailing Address - Fax:787-831-4175
Practice Address - Street 1:AVE HOSTOS KM 159.4
Practice Address - Street 2:SUITE 1
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1512
Practice Address - Country:US
Practice Address - Phone:787-652-3800
Practice Address - Fax:787-652-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty