Healthcare Provider Details

I. General information

NPI: 1649276932
Provider Name (Legal Business Name): JAIME DE JESUS VINAS D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 CALLE COLON - ROOSEVELT
SAN JUAN PR
00918-2701
US

IV. Provider business mailing address

PO BOX 364771
SAN JUAN PR
00936-4771
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-5912
  • Fax: 787-764-3441
Mailing address:
  • Phone: 787-756-5912
  • Fax: 787-764-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number000833
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: