Healthcare Provider Details

I. General information

NPI: 1023575768
Provider Name (Legal Business Name): JEO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON STE 201
SAN JUAN PR
00917-5023
US

IV. Provider business mailing address

26 CALLE BELEN
GUAYNABO PR
00968-3123
US

V. Phone/Fax

Practice location:
  • Phone: 787-771-1000
  • Fax: 787-771-1001
Mailing address:
  • Phone: 787-708-6456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE J ECHENIQUE ARANA
Title or Position: SOLE MBR
Credential: MD
Phone: 787-708-6456