Healthcare Provider Details

I. General information

NPI: 1790181667
Provider Name (Legal Business Name): JUAN JOSE BAYRON JUSTINIANO, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1791 CALLE ESTEBAN PADILLA SANTIAGO IGLESIAS
SAN JUAN PR
00921-4237
US

IV. Provider business mailing address

1791 CALLE ESTEBAN PADILLA SANTIAGO IGLESIAS
SAN JUAN PR
00921-4237
US

V. Phone/Fax

Practice location:
  • Phone: 787-783-0399
  • Fax: 787-793-3965
Mailing address:
  • Phone: 787-783-0399
  • Fax: 787-793-3965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JUAN JOSE BAYRON JUSTINIANO
Title or Position: PRESIDENT
Credential: M.D
Phone: 787-783-0399