1578695805 NPI number — DR. PEDRO JAIME BEAUCHAMP M.D.

Table of content: DR. PEDRO JAIME BEAUCHAMP M.D. (NPI 1578695805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578695805 NPI number — DR. PEDRO JAIME BEAUCHAMP M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEAUCHAMP
Provider First Name:
PEDRO
Provider Middle Name:
JAIME
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578695805
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 PASEO SAN PABLO STE 503
Provider Second Line Business Mailing Address:
DR. ARTURO CADILLA BLDG.
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00961-7028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-798-0100
Provider Business Mailing Address Fax Number:
787-740-7250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARIBBEAN HEALTHCARE MANAGEMENT GROUP, LLC
Provider Second Line Business Practice Location Address:
150 AVE DE DIEGO STE 1 SAN JUAN HEALTH CENTRE
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-798-0100
Provider Business Practice Location Address Fax Number:
787-740-7250
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  7010 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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