Provider Demographics
NPI:1326791849
Name:ORTHO ELITE GROUP LLC
Entity Type:Organization
Organization Name:ORTHO ELITE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-664-8721
Mailing Address - Street 1:VILLA BORINQUEN 31 C/LOPEZ LANDRON
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:313 CARR 869
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-7075
Practice Address - Country:US
Practice Address - Phone:787-664-8721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier