Healthcare Provider Details

I. General information

NPI: 1295703304
Provider Name (Legal Business Name): ANTONIO J JELU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD 149 KM 12.3
CIALES PR
00638
US

IV. Provider business mailing address

PO BOX 1427
CIALES PR
00638-1427
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-0601
  • Fax: 787-871-3960
Mailing address:
  • Phone: 787-871-0601
  • Fax: 787-871-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3980
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: