Healthcare Provider Details

I. General information

NPI: 1982689808
Provider Name (Legal Business Name): JESUS M ALVELO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAYAMON MEDICAL PLZ SUITE 310
BAYAMON PR
00959-7200
US

IV. Provider business mailing address

PO BOX 1397
VEGA ALTA PR
00692-1397
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-6025
  • Fax:
Mailing address:
  • Phone: 787-786-6025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7443
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: