Healthcare Provider Details

I. General information

NPI: 1982124145
Provider Name (Legal Business Name): JPM ENT SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA ASHFORD #1451
SAN JUAN PR
00902
US

IV. Provider business mailing address

PO BOX 23318
SAN JUAN PR
00931-3318
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-2160
  • Fax:
Mailing address:
  • Phone: 787-406-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number019538
License Number StatePR

VIII. Authorized Official

Name: DR. JEAMARIE PASCUAL MARRERO
Title or Position: PRESIDENT
Credential: MD, MPH
Phone: 787-406-0301