Provider Demographics
NPI:1053962514
Name:PEDIATRIC ORTHOPEDICS OF PUERTO RICO
Entity type:Organization
Organization Name:PEDIATRIC ORTHOPEDICS OF PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:DEL VALLE HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-478-0782
Mailing Address - Street 1:PO BOX 3073
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3073
Mailing Address - Country:US
Mailing Address - Phone:787-478-0782
Mailing Address - Fax:
Practice Address - Street 1:410 AVENIDA HOSTOS CARR #2 KM 157
Practice Address - Street 2:SUITE 117
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-478-0782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty