Healthcare Provider Details

I. General information

NPI: 1538556568
Provider Name (Legal Business Name): JSR COLORECTAL PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 AVENIDA ASHFORD EDIFICIO ADALIGIA SUITE 1
SAN JUAN PR
00907
US

IV. Provider business mailing address

PO BOX 2528
GUAYNABO PR
00970-2528
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-9595
  • Fax: 787-724-9494
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number17478
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE S REYES TORRES
Title or Position: OWNER
Credential:
Phone: 787-724-9595