Healthcare Provider Details

I. General information

NPI: 1760548895
Provider Name (Legal Business Name): JAIME JOSE ESCALONA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 AVE WINSTON CHURCHILL SUITE 4
SAN JUAN PR
00926-6064
US

IV. Provider business mailing address

B3 CALLE 1 VILLAS DE SAN FRANCISCO
SAN JUAN PR
00927-6449
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-8798
  • Fax: 787-763-2696
Mailing address:
  • Phone: 787-764-8798
  • Fax: 787-763-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number071
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: