Provider Demographics
NPI:1629471933
Name:INNOVASIVE MEDICAL INC
Entity Type:Organization
Organization Name:INNOVASIVE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-414-7607
Mailing Address - Street 1:PO BOX 367968
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-7968
Mailing Address - Country:US
Mailing Address - Phone:787-414-7607
Mailing Address - Fax:188-887-1961
Practice Address - Street 1:ESTANCIAS DEL BLVD
Practice Address - Street 2:7000 CARR. 844, APT. 6A6
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9570
Practice Address - Country:US
Practice Address - Phone:787-414-7607
Practice Address - Fax:188-887-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier