Healthcare Provider Details

I. General information

NPI: 1952468126
Provider Name (Legal Business Name): JCM PEDIATRIC HOSPITALIST SERVICES OF PUERTO RICO CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KM 11.9 INTERIOR BO. PAJAROS PUERTO RICO CHILDREN'S HOSPITAL
BAYAMON PR
00959
US

IV. Provider business mailing address

B-22 SOUTHVIEW CT., BALDWIN PARK
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-974-8282
  • Fax:
Mailing address:
  • Phone: 787-731-2721
  • Fax: 787-790-2518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10867
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE MANUEL CANTELLOPS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-731-2721