Provider Demographics
NPI:1639440498
Name:ONE SPINE CORPORATION
Entity Type:Organization
Organization Name:ONE SPINE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-371-1919
Mailing Address - Street 1:PO BOX 1103
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-1103
Mailing Address - Country:US
Mailing Address - Phone:787-892-6972
Mailing Address - Fax:787-892-6972
Practice Address - Street 1:TORRE SAN VICENTE DE PAUL
Practice Address - Street 2:SUITE 309
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-6972
Practice Address - Fax:787-892-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier