Provider Demographics
NPI:1023438710
Name:ORTHOPAEDIC SPECIALTIES INSTITUTE,PSC
Entity type:Organization
Organization Name:ORTHOPAEDIC SPECIALTIES INSTITUTE,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ-SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-841-1085
Mailing Address - Street 1:2105 CALLE MONACO APT 104
Mailing Address - Street 2:PASEO DE LA PRINCESA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-3622
Mailing Address - Country:US
Mailing Address - Phone:787-841-1085
Mailing Address - Fax:787-651-5580
Practice Address - Street 1:2435 BLVD LUIS A FERRE
Practice Address - Street 2:HOSPITAL METROPOLITANO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2112
Practice Address - Country:US
Practice Address - Phone:787-841-1085
Practice Address - Fax:787-651-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16588207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHT671AMedicare PIN