Healthcare Provider Details

I. General information

NPI: 1750062360
Provider Name (Legal Business Name): JEAN A DELICE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JEAN A DELICE MD

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVE LUIS MUNOZ MARIN
CAGUAS PR
00725-6184
US

IV. Provider business mailing address

100 AVE LUIS MUNOZ MARIN
CAGUAS PR
00725-6184
US

V. Phone/Fax

Practice location:
  • Phone: 787-920-4090
  • Fax: 787-363-9900
Mailing address:
  • Phone: 787-920-4090
  • Fax: 787-363-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001190-P.A
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10073
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: