Healthcare Provider Details

I. General information

NPI: 1306112487
Provider Name (Legal Business Name): JORGE LUIS WEBER GUZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO MEDICO DE CAYEY OFICINA 205
CAYEY PR
00736-4107
US

IV. Provider business mailing address

CENTRO MEDICO DE CAYEY OFICINA 205
CAYEY PR
00736-4107
US

V. Phone/Fax

Practice location:
  • Phone: 787-639-8835
  • Fax:
Mailing address:
  • Phone: 787-639-8835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number57890
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number21351
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: