Healthcare Provider Details

I. General information

NPI: 1720531874
Provider Name (Legal Business Name): JESSICA ABREU-GARCIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1010 PASEO DEL VETERANO
PONCE PR
00716-2001
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5000
  • Fax:
Mailing address:
  • Phone: 787-492-0113
  • Fax: 787-812-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number14069
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number21327
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2084N0400X
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number22624
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: