Provider Demographics
NPI:1255799946
Name:MEDI TECH ORTHOPEDICS INC
Entity type:Organization
Organization Name:MEDI TECH ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-206-1387
Mailing Address - Street 1:PO BOX 43002
Mailing Address - Street 2:SUITE 431
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-6601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1135 AVE 65 INFANTERIA
Practice Address - Street 2:ITURREGUI PLAZA SUITE 202 B
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3402
Practice Address - Country:US
Practice Address - Phone:787-206-1387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier