Provider Demographics
NPI:1851544613
Name:ERA ORTHOPEDICS CORP.
Entity Type:Organization
Organization Name:ERA ORTHOPEDICS CORP.
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:ORTHOPEDIC TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:EDIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:TO
Authorized Official - Phone:787-889-3191
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-1449
Mailing Address - Country:US
Mailing Address - Phone:787-889-3191
Mailing Address - Fax:787-889-4313
Practice Address - Street 1:PLAYA AZUL CENTER LOCAL 4 C/193 KM 1.0
Practice Address - Street 2:
Practice Address - City:LUQUILLO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00738
Practice Address - Country:UM
Practice Address - Phone:787-889-3191
Practice Address - Fax:787-889-4313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRNONE332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies