Provider Demographics
NPI:1174830996
Name:INSTITUTO ORTOPEDICO PLAZA PSC
Entity Type:Organization
Organization Name:INSTITUTO ORTOPEDICO PLAZA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODRIGUEZ-WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-751-0909
Mailing Address - Street 1:PMB #91
Mailing Address - Street 2:PO BOX 70344
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936
Mailing Address - Country:US
Mailing Address - Phone:787-751-0909
Mailing Address - Fax:787-763-5080
Practice Address - Street 1:525 AVE FD ROOSEVELT
Practice Address - Street 2:TORRE DE PLAZA LAS AMERICAS SUITE 707-708
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8001
Practice Address - Country:US
Practice Address - Phone:787-751-0909
Practice Address - Fax:787-763-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9642174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG40926Medicare UPIN