1720555428 NPI number — J&M PRIMARY CARE PHYSICIANS PSC

Table of content: (NPI 1720555428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720555428 NPI number — J&M PRIMARY CARE PHYSICIANS PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J&M PRIMARY CARE PHYSICIANS PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1720555428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
REPARTO UNIVERSIDAD
Provider Second Line Business Mailing Address:
I 16 CALLE 2
Provider Business Mailing Address City Name:
SAN GERMAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-538-0708
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 CALLE 65 DE INFANTERIA S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAJAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00667-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-899-0925
Provider Business Practice Location Address Fax Number:
787-899-0925
Provider Enumeration Date:
10/31/2018

Additional Information

Authorized Official

Authorized Official Last Name:
FIGUEROA SOSA
Authorized Official First Name:
JAIME
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MD/PRESIDENT
Authorized Official Telephone Number:
787-538-0708

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 19852 . This is a "PUERTO RICO PHYSICIAN LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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