Provider Demographics
NPI:1578560447
Name:HOME ORTHOPEDICS CORP
Entity Type:Organization
Organization Name:HOME ORTHOPEDICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:G
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:787-763-1002
Mailing Address - Street 1:202 CALLE FEDERICO COSTA
Mailing Address - Street 2:URB TRES MONJITAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1321
Mailing Address - Country:US
Mailing Address - Phone:787-763-1002
Mailing Address - Fax:787-763-1004
Practice Address - Street 1:202 CALLE FEDERICO COSTA
Practice Address - Street 2:URB TRES MONJITAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1321
Practice Address - Country:US
Practice Address - Phone:787-763-1002
Practice Address - Fax:787-763-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0309920002Medicare NSC