Provider Demographics
NPI:1942625694
Name:O L A S P.S.C.
Entity Type:Organization
Organization Name:O L A S P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-550-5711
Mailing Address - Street 1:PO BOX 11747
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-2847
Mailing Address - Country:US
Mailing Address - Phone:787-722-7302
Mailing Address - Fax:787-722-7303
Practice Address - Street 1:1503 CALLE PROF AUGUSTO RODRIGUEZ
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2275
Practice Address - Country:US
Practice Address - Phone:787-722-7302
Practice Address - Fax:787-722-7303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41444Medicare UPIN