Provider Demographics
NPI:1538125349
Name:BAYAMON PROSTHETICS & ORTHOTICS INC
Entity Type:Organization
Organization Name:BAYAMON PROSTHETICS & ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ADOLFO
Authorized Official - Last Name:GOSS GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-640-8788
Mailing Address - Street 1:2135 CARR #2
Mailing Address - Street 2:STE 15 PMB 121
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5259
Mailing Address - Country:US
Mailing Address - Phone:787-787-5555
Mailing Address - Fax:787-269-8843
Practice Address - Street 1:CARR #2 KM 14.4
Practice Address - Street 2:HATO TEJAS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-787-5555
Practice Address - Fax:787-269-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECP1317224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5631700001Medicare ID - Type Unspecified