Healthcare Provider Details

I. General information

NPI: 1730015967
Provider Name (Legal Business Name): JAMILLEZ OLMO CLASSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 7 BOX 12112
ARECIBO PR
00612-8603
US

IV. Provider business mailing address

HC 7 BOX 12112
ARECIBO PR
00612-8603
US

V. Phone/Fax

Practice location:
  • Phone: 787-320-5435
  • Fax:
Mailing address:
  • Phone: 787-320-5435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3114
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: