Healthcare Provider Details

I. General information

NPI: 1760468938
Provider Name (Legal Business Name): JAIME A VIQUEIRA SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 CALLE ESTACION ESQUINA VIRGINIA
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 1780
MAYAGUEZ PR
00681
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-9696
  • Fax: 787-833-9796
Mailing address:
  • Phone: 787-833-9696
  • Fax: 787-833-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5044
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: