Healthcare Provider Details

I. General information

NPI: 1477583144
Provider Name (Legal Business Name): JESUS R CASAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

B-30 POPPY S.T. PARQUE FORESTAL
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax: 787-641-9541
Mailing address:
  • Phone: 787-287-7034
  • Fax: 787-641-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number12459
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number12459
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number12459
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: