1780898650 NPI number — JASAES MEDICAL DIAGNOSTIC INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780898650 NPI number — JASAES MEDICAL DIAGNOSTIC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JASAES MEDICAL DIAGNOSTIC INC.
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:
6
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:
1780898650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 AVE RIO HONDO
Provider Second Line Business Mailing Address:
PMB STE 275
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00961-3105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-870-3080
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 165 KM 10.2
Provider Second Line Business Practice Location Address:
STE 100 LILY MINI MALL
Provider Business Practice Location Address City Name:
TOA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-870-3080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CABALLERO
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-870-3080

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  224843 , 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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