MEDICARE: JEZREELCITAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	344600000X	Taxi	PCVTE 4440	PR

General Provider Information

NPI Number	:	1023360070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEZREELCITAS

Provider Business Mailing Address
First Line	:	PO BOX 987
Second Line	:
City	:	SAN LORENZO
State	:	PR
Zip	:	00754-0987
Country	:	US
Telephone Number	:	787-370-5021
Fax Number	:	787-715-2221

Provider Business Practice Location Address
First Line	:	BO. FLORIDA CARRETERA 183 RAMAL 9929
Second Line	:	KM 1.6
City	:	SAN LORENZO
State	:	PR
Zip	:	00754-0000
Country	:	US
Telephone Number	:	787-370-5021
Fax Number	:	787-715-2221

Authorized Official
Title or Position	:	PESIDENT
Name	:	MR. OSVALDO ORTIZ
Credential	:
Telephone Number	:	787-370-5021

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	10/15/2012

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Directions to “JEZREELCITAS ” Practice Location

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