Provider Demographics
NPI:1518117175
Name:PONCE ORTHOPAEDIC TRAUMA INSTITUTE PSC
Entity Type:Organization
Organization Name:PONCE ORTHOPAEDIC TRAUMA INSTITUTE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SERRA TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-710-6342
Mailing Address - Street 1:URB. TERRA SENORIAL
Mailing Address - Street 2:141 CASTANIA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731
Mailing Address - Country:US
Mailing Address - Phone:718-710-6342
Mailing Address - Fax:
Practice Address - Street 1:2225 PONCE BY PASS
Practice Address - Street 2:EDIFICIO PARRA OFICE 805
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1321
Practice Address - Country:US
Practice Address - Phone:718-710-6342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17144207X00000X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty