Provider Demographics
NPI:1649392556
Name:HEALTH CARE CENTER OF ORTHOTICS AND PROSTHETICS OF PR INC
Entity Type:Organization
Organization Name:HEALTH CARE CENTER OF ORTHOTICS AND PROSTHETICS OF PR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GUARRASI
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:571-436-7389
Mailing Address - Street 1:2852 HARTLAND RD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-3526
Mailing Address - Country:US
Mailing Address - Phone:571-436-7389
Mailing Address - Fax:
Practice Address - Street 1:13 CALLE GUARIONEX
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4408
Practice Address - Country:US
Practice Address - Phone:787-946-4225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR165387332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6025700001Medicare NSC