Healthcare Provider Details

I. General information

NPI: 1386815264
Provider Name (Legal Business Name): J.C. ISLAND LITHOTRIPSY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO SAINT LUKES MEMORIAL HOSPITAL INC SECOND FLOOR IN FRONT OF OR
PONCE PR
00716-4717
US

IV. Provider business mailing address

609 AVE TITO CASTRO STE 102 PMB 382
PONCE PR
00716-0200
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-2080
  • Fax: 787-840-5390
Mailing address:
  • Phone: 787-844-2080
  • Fax: 787-840-5390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. FELIX MENDOZA-ROSA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-844-2080