MEDICARE: JACE VARO AVETISYAN MD

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	208D00000X	General Practice Physician	17582-I	PR

General Provider Information

NPI Number	:	1447115647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACE VARO AVETISYAN MD

Provider Business Mailing Address
First Line	:	100 CARMEN HILLS DR APT 110
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-9642
Country	:	US
Telephone Number	:	323-282-0798
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CARMEN HILLS DR APT 110
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-9642
Country	:	US
Telephone Number	:	323-282-0798
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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