JDDM Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

103 Issued in PR

Legal business name

JDDM INC

Doing business as

New Balance Puerto Rico

Practice address

210 Ave Carlos Chardon Ste 104
San Juan, PR 00918-1716

Phone

(787) 756-2121

NPI assigned

Jan 26, 2013

Last updated

Jan 26, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jose C Rodriguez-Portela, DPM

Title

Secretary

Phone

(787) 344-3553

Specialties & licenses 1

Addresses

Other names 1

• New Balance Puerto Rico Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359158400000",
    "number": "1881932838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 AVE CARLOS CHARDON STE 104",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009181716",
            "telephone_number": "787-756-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 AVE CARLOS CHARDON STE 104",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009181716",
            "telephone_number": "787-756-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JDDM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-26",
        "last_updated": "2013-01-26",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ-PORTELA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "787-344-3553",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "PR",
            "license": "103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Balance Puerto Rico",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Prosthetic/Orthotic Supplier in San Juan, PR
• Providers in San Juan, PR by specialty
• Prosthetic/Orthotic Supplier in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.